OBJECTIVES: To estimate outcomes according to
attained blood pressure (BP) in the oldest adults treated
for hypertension in routine family practice.
DESIGN: Cohort analysis of primary care inpatient and
death certificate data for individuals with hypertension.
SETTING: Primary care practices in England (Clinical
Practice Research ...
OBJECTIVES: To estimate outcomes according to
attained blood pressure (BP) in the oldest adults treated
for hypertension in routine family practice.
DESIGN: Cohort analysis of primary care inpatient and
death certificate data for individuals with hypertension.
SETTING: Primary care practices in England (Clinical
Practice Research Datalink).
PARTICIPANTS: 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.
MEASUREMENTS: 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.
CONCLUSION: 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.
