title: Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality?
abstract: OBJECTIVE
  To determine the association between hypertension at age 90 years, treatment, and 5-year mortality.
  
  
  METHODS
  A prospective observational study of a representative community-dwelling birth cohort (born 1920-1921) by the Jerusalem Longitudinal Study (1990-2015).
  
  
  METHODS
  Home-assessment.
  
  
  METHODS
  480 subjects aged 90, examined 2010-2011. Measurements and Main Outcome: Hypertension was defined as treatment with antihypertensive medication, and/or sitting blood pressure (BP) > 140 mmHg systolic or >90 mmHg diastolic. Subjects were categorized as normotensive (NORMO), untreated hypertensive (NonTx-HTN), and treated hypertensive (Tx-HTN); assessment included activities of daily living (ADL), handgrip strength, and all-cause mortality (2010-2015).
  
  
  RESULTS
  NORMO, NonTx-HTN, and Tx-HTN prevalence was 12.3% (59/480), 12.7% (61/480), and 75% (360/480). Tx-HTN had higher rates of low education, depression, low physical activity, chronic heart failure, ischemic heart disease, chronic kidney disease. Five-year survival was lowest among Tx-HTN and highest among NonTx-HTN versus NORMO among all subjects (51%, 72%, 61%; P = .01), and subgroups with ADL independence (64%, 91%, 74%; n = 265, P = .01), ADL dependence (37%, 55%, 48%; n = 194, P = .36), high grip strength (66%, 85%, 83%; n = 227, P = .04), low grip strength (38%, 60%, 61%; n = 149, P = .06), low comorbidity (64%, 84%, 70%; n = 219, P = .13), and high comorbidity (42%, 60%, 54%; n = 257, P = .12). Unadjusted mortality hazards ratios (HR) were higher for Tx-HTN [HR 1.38; 95% confidence interval (CI) 0.89-2.15] versus NonTx-HTN (HR 0.7; 95% CI 0.37-1.31) compared to NORMO (HR 1.0). After adjusting for medical and functional covariates, adjusted HRs were higher for Tx-HTN (HR 1.39; 95% CI 0.83-2.33) versus NonTx-HTN (HR 0.67; 95% CI 0.31-1.45) compared to NORMO (HR 1.0). Findings were consistent in subsets according to ADL status, grip strength, and comorbidity.
  
  
  CONCLUSIONS
  Untreated hypertension at age 90 years was not associated with increased mortality risk among community-dwelling elderly, irrespective of comorbidity, functional status, or muscle strength.
authors.affiliation: Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Jochanan
authors.initials: J
authors.lastname: Stessman
authors.affiliation: Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Bursztyn
authors.affiliation: Hebrew University-Hadassah Medical School, Jerusalem, Israel; Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Gershinsky
authors.affiliation: Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Aliza
authors.initials: A
authors.lastname: Hammerman-Rozenberg
authors.affiliation: Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hebrew University-Hadassah Medical School, Jerusalem, Israel. Electronic address: jacobsj@hadassah.org.il.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Jacobs
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D018737:Hand Strength; D006707:Homes for the Aged; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007557:Israel; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends*; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: Hypertension; antihypertensive treatment; cohort; handgrip; mortality; oldest old