title: Outcomes of Treated Hypertension at Age 80 and Older: Cohort Analysis of 79,376 Individuals.
abstract: OBJECTIVE
  To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice.
  
  
  METHODS
  Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension.
  
  
  METHODS
  Primary care practices in England (Clinical Practice Research Datalink).
  
  
  METHODS
  Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline.
  
  
  METHODS
  Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10-mmHg increments from less than 125 to 185 mmHg or more (reference 145-154 mmHg).
  
  
  RESULTS
  Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19-1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short- and long-term follow-up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group.
  
  
  CONCLUSIONS
  In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care.
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: João
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.|Healthcare for Older People, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, United Kingdom.
authors.forename: Jane A H
authors.initials: JAH
authors.lastname: Masoli
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Bowman
authors.affiliation: Healthcare for Older People, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, United Kingdom.|Department of Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: W David
authors.initials: WD
authors.lastname: Strain
authors.affiliation: Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: George A
authors.initials: GA
authors.lastname: Kuchel
authors.affiliation: Institute of Epidemiology and Health, University College London Gower Street Campus, London, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Lafortune
authors.affiliation: Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.|Center on Aging, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: David
authors.initials: D
authors.lastname: Melzer
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Alessandro
authors.identifier: http://orcid.org/0000-0003-4917-3810
authors.initials: A
authors.lastname: Ble
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D009026:Mortality; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: hypertension; mortality; oldest old; outcomes; primary care