Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality
dc.contributor.author | Masoli, JAH | |
dc.contributor.author | Delgado, J | |
dc.contributor.author | Pilling, L | |
dc.contributor.author | Strain, D | |
dc.contributor.author | Melzer, D | |
dc.date.accessioned | 2020-06-18T13:19:25Z | |
dc.date.issued | 2020-03-05 | |
dc.description.abstract | BACKGROUND: Blood pressure (BP) management in frail older people is challenging. An randomised controlled trial of largely non-frail older people found cardiovascular and mortality benefit with systolic (S) BP target <120 mmHg. However, all-cause mortality by attained BP in routine care in frail adults aged above 75 is unclear. OBJECTIVES: To estimate observational associations between baseline BP and mortality/cardiovascular outcomes in a primary-care population aged above 75, stratified by frailty. METHODS: Prospective observational analysis using electronic health records (clinical practice research datalink, n = 415,980). We tested BP associations with cardiovascular events and mortality using competing and Cox proportional-hazards models respectively (follow-up ≤10 years), stratified by baseline electronic frailty index (eFI: fit (non-frail), mild, moderate, severe frailty), with sensitivity analyses on co-morbidity, cardiovascular risk and BP trajectory. RESULTS: Risks of cardiovascular outcomes increased with SBPs >150 mmHg. Associations with mortality varied between non-frail <85 and frail 75-84-year-olds and all above 85 years. SBPs above the 130-139-mmHg reference were associated with lower mortality risk, particularly in moderate to severe frailty or above 85 years (e.g. 75-84 years: 150-159 mmHg Hazard Ratio (HR) mortality compared to 130-139: non-frail HR = 0.94, 0.92-0.97; moderate/severe frailty HR = 0.84, 0.77-0.92). SBP <130 mmHg and Diastolic(D)BP <80 mmHg were consistently associated with excess mortality, independent of BP trajectory toward the end of life. CONCLUSIONS: In representative primary-care patients aged ≥75, BP <130/80 was associated with excess mortality. Hypertension was not associated with increased mortality at ages above 85 or at ages 75-84 with moderate/severe frailty, perhaps due to complexities of co-existing morbidities. The priority given to aggressive BP reduction in frail older people requires further evaluation. | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.identifier.citation | Published online 5 March 2020 | en_GB |
dc.identifier.doi | 10.1093/ageing/afaa028 | |
dc.identifier.other | 5775492 | |
dc.identifier.uri | http://hdl.handle.net/10871/121519 | |
dc.language.iso | en | en_GB |
dc.publisher | Oxford University Press for British Geriatrics Society | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/32133525 | en_GB |
dc.rights | © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | en_GB |
dc.subject | blood pressure | en_GB |
dc.subject | frailty | en_GB |
dc.subject | hypertension | en_GB |
dc.title | Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2020-06-18T13:19:25Z | |
exeter.place-of-publication | England | en_GB |
dc.description | This is the final version. Available on open access from Oxford University Press via the DOI in this record | en_GB |
dc.description | Data access statement: CPRD data on which the analyses was based is held securely by University of Exeter Medical School under the CPRD data access licence (https://www.cprd.com/dataAccess/). | en_GB |
dc.identifier.journal | Age and Ageing | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0/ | en_GB |
dcterms.dateAccepted | 2020-01-24 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2020-03-05 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2020-06-18T13:17:26Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2020-06-18T13:19:30Z | |
refterms.panel | A | en_GB |
refterms.depositException | publishedGoldOA |
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This is an Open Access article distributed under the terms of the Creative Commons Attribution
Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits
non-commercial re-use, distribution, and reproduction in any medium, provided the original work is
properly cited. For commercial re-use, please contact journals.permissions@oup.com