title: Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission.
abstract: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension.
  
  
  
  the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people.
  
  
  
  a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent.
  
  
  
  a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission.
  
  
  
  the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.
authors: Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
authors: Yvonne
authors: Y
authors: Morrissey
authors: Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent  CT1 3NG, UK.
authors: Michael
authors: M
authors: Bedford
authors: Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent  CT1 3NG, UK.
authors: Jean
authors: J
authors: Irving
authors: Renal Medicine, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent  CT1 3NG, UK.
authors: Chris K T
authors: CK
authors: Farmer
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007022:Hypotension / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D010343:Patient Admission; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: acute kidney injury; hospital admission; hypotension; mortality; older people