title: Influence of Blood Pressure and Other Clinical Variables on Long-Term Mortality in a Cohort of Elderly Subjects with Type 2 Diabetes.
abstract: BACKGROUND
  Diabetes mellitus and high blood pressure (HBP) are commonly associated conditions in the elderly population. An effect of treatments, biologic and anthropometric variables on long-term mortality is unknown in this population.
  
  
  OBJECTIVE
  To determine the prevalence of HBP control in a sample of elderly patients with type 2 diabetes with office blood pressure (BP) readings and ambulatory blood pressure monitoring (ABPM) and evaluate the influence of BP, anthropometric and laboratory variables on long term mortality.
  
  
  METHODS
  Cohort study in patients living at home in the area of Sherbrooke, ≥65 years old, receiving reimbursement for antidiabetic medication. The study included medical history, 2 sets of BP measurements, 2 24-hour urinary collections for microalbuminuria, 1 24-hour ABPM, blood level of creatinine and glycosylated hemoglobin. Charts were reanalyzed 8 years later for analysis of cardiovascular and total mortality cases.
  
  
  RESULTS
  198 patients were initially recruited. By history, 83% of the subjects had diagnoses and treatments for high blood pressure. In multivariate analysis, factors associated with an 8-year increased risk for cardiovascular mortality were creatinine ≥84 µmol/L, office seated systolic blood pressure ≤130 and diastolic BP ≤67.6 over 24 hours. Factors associated with total mortality were lower waist circumference, serum creatinine ≥84 and diastolic BP ≤67.6 over 24 hours.
  
  
  CONCLUSIONS
  Lower systolic and diastolic BP (office and ABPM), lower waist circumference and higher creatinine values are associated with an increased mortality risk. This suggests that a lower BP, declining kidney function and frailty are factors associated with this observation.
authors.affiliation: Geriatric Division, Centre Intégré Universitaire de Soins et Services en Santé de L'Estrie (CIUSSS)-CHUS, Sherbrooke, Québec, Canada. Electronic address: dtessier.csss-iugs@ssss.gouv.qc.ca.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Tessier
authors.affiliation: Geriatric Division, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Graydon S
authors.initials: GS
authors.lastname: Meneilly
authors.affiliation: Centre Hospitalier de Gatineau, Gatineau, Québec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Moleski
authors.affiliation: Research Center on Aging, Sherbrooke, Québec, Canada.
authors.forename: Lise
authors.initials: L
authors.lastname: Trottier
authors.affiliation: Internal Medicine Division, CIUSSS de l'Estrie-CHUS, Sherbrooke, Québec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Lanthier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D057210:Delayed Diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D005260:Female; D016330:Frail Elderly; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D007022:Hypotension / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008508:Medication Errors; D009026:Mortality; D015995:Prevalence; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D055105:Waist Circumference
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine
keywords: Ambulatory blood pressure monitoring; Diabetes mellitus; Diabète sucré; Elderly; High blood pressure, mortality; Hypertension artérielle; Monitorage ambulatoire de la pression artérielle; Mortalité; Âgé/personnes âgées