title: On-Treatment Blood Pressure and Cardiovascular Outcomes in Older Adults With Isolated Systolic Hypertension.
abstract: Our aim was to assess optimal on-treatment blood pressure (BP) at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in Japanese older adults with isolated systolic hypertension. We used data from the VALISH study (Valsartan in Elderly Isolated Systolic Hypertension) that recruited older adults (n=3035; mean age, 76 years) with systolic BP (SBP) of ≥160 mm Hg and diastolic BP of <90 mm Hg. Patients were treated by valsartan. Patients were also categorized into 3 groups based on achieved on-treatment SBP of <130 mm Hg (n=317), 130 to <145 mm Hg (n=2025), or ≥145 mm Hg (n=693). The primary outcome was composite CVD (coronary heart disease, stroke, heart failure, cardiovascular deaths, other vascular diseases, and kidney diseases) with secondary outcome being all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group. Over a median 3-year follow-up (8022 person-years), 93 CVD events and 52 deaths occurred. Using the on-treatment SBP of 130 to <145 mm Hg as reference stratum, the multivariable-adjusted hazard ratios and 95% confidence intervals of CVD and all-cause mortality risks for those with SBP<130 mm Hg were 2.08 (1.12-3.83) and 2.09 (0.93-4.71) and for those with SBP≥145 mm Hg were 2.29 (1.44-3.62) and 2.51 (1.35-4.66), respectively. On-treatment diastolic BP yielded no relationships with CVD or all-cause mortality risk. In conclusion, among Japanese older adults with isolated systolic hypertension, SBP in the range between 130 and 144 mm Hg was associated with minimal adverse outcomes and a reduction in CVD and all-cause mortality. The BP range will need to be confirmed in randomized controlled trials.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT00151229.
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.). yyano@jichi.jp yyano@umc.edu.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Takao
authors.initials: T
authors.lastname: Saruta
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001795:Blood Pressure Determination; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013599:Systole
chemical_list: D000959:Antihypertensive Agents
keywords: U-shaped relationship; blood pressure; cardiovascular diseases; elderly; hypertension; mortality