Blood pressure and mortality in elderly people aged 85 and older: community based study

BMJ 1998;316:1780-1784 ( 13 June )

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Blood pressure and mortality in elderly people aged 85 and older: community based study

Hendriek C Boshuizen, epidemiologist, ^a Gerbrand J Izaks, research fellow, ^b Stef van Buuren, statistician, ^a Gerard J Ligthart, associate professor. ^b

^a TNO Prevention and Health, Division of Public Health and Prevention, Leiden, Netherlands, ^b Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Centre, Leiden

Correspondence to: Dr Boshuizen HC.Boshuizen{at}PG.TNO.NL

Objective: To determine whether the inverse relation between blood pressure and all cause mortality in elderly peopleover 85 years of age can be explained by adjusting for healthstatus, and to determine whether high blood pressure is a riskfactor for mortality when the effects of poor health are accountedfor.
Design: 5 to 7 year follow up of community residents aged 85 years and older.
Setting: Leiden, the Netherlands.
Subjects: 835 subjects whose blood pressure was recorded between 1987 and 1989.
Main outcome measure: All cause mortality.
Results: An inverse relation between blood pressure and all cause mortality was observed. For diastolic blood pressure crude 5 year all cause mortality decreased from 88% (52/59) (95% confidence interval 79% to 95%) in those with diastolic blood pressures <65 mm Hg to 59% (27/46) (44% to 72%) in those with diastolic pressures >100 mm Hg. For systolic blood pressure crude5 year all cause mortality decreased from 85% (95/112) (78% to91%) in those with systolic pressures <125 mm Hg to 59% (13/22)(38% to 78%) in those with systolic pressures >200 mm Hg. Thisdecrease was no longer significant after adjustment for indicatorsof poor health. No relation existed between blood pressure andmortality from cardiovascular causes or stroke after adjustmentfor age and sex, but after adjustment for age, sex, and indicatorsof poor health there was a positive relation between diastolicblood pressure and mortality from both cardiovascular causes andstroke.
Conclusion: The inverse relation between blood pressure and all cause mortality in elderly people over 85 is associatedwith health status.

Key messages

Among community residents aged 85 and older there was a paradoxical inverse relation between blood pressure and all cause mortality: higher blood pressure was associated with lower mortality
This inverse relation seems mainly to be due to higher mortality in those with low blood pressure; low blood pressure seems to be caused by poor health
There was no longer a significant relation between blood pressure and all cause mortality after adjusting for health status. However, there was a positive relation between diastolic blood pressure and mortality from both cardiovascular causes and stroke
Treating hypertension does not shorten life expectancy among elderly people aged 85 and older, and it might prevent disability from stroke

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