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Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2158 (Published 05 June 2018) Cite this as: BMJ 2018;361:k2158

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Managing blood pressure in older adults

Re: Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study

I read the article by Ly, et. al. with interest, but I am not sure what the authors intended to ultimately convey. The overall mortality in their three-year follow-up was 42.8% (1997/4658) for this elderly population who averaged just over 92 years of age. They found that the subgroup with the lowest systolic blood pressures had an adjusted hazard ratio of 1.30 and the subgroup with the highest systolic blood pressures had an adjusted hazard ratio of 1.16 compared to those in the subgroup between. Using a rough calculation, this would seem to mean that those who were in the subgroup with the highest systolic blood pressure would have, on average, a life span shortened by five to six months compared to the reference. Would the authors recommend a change in clinical care in elderly patients with higher systolic blood pressures and if so, is there evidence that this would have the intended effect of prolonging life? Or perhaps the authors intended this as a tool to assist with end-of-life planning, increasing the urgency for those with higher systolic blood pressures. It would be interesting to determine what the authors were interested in clinically that goes beyond their statistical methodology.

Competing interests: No competing interests

05 June 2018
Alan R. Ertle
Physician Administrator
Emeritus Enterprises
20532 Jacklight Lane, Bend, Oregon 97702 (USA)