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Blood Pressure and Mortality in the Very Old

Patients with systolic BP <140 mm Hg had significantly increased all-cause mortality risk.

Whether blood pressure (BP) is associated with all-cause mortality in very old people is unclear. In this study, researchers recorded the BPs of nearly all very old residents (age, 85) of a Finnish city and followed them for as long as 9 years. At baseline, mean BP was 149/82 mm Hg; systolic BP was 160 mm Hg in 35% of participants.

Of the 521 participants, 87% died during follow-up. In a multivariate analysis adjusted for numerous clinical characteristics (including cardiovascular disease, cancer, diabetes, previously diagnosed hypertension, and use of antihypertensive drugs), patients with systolic BP <140 mm Hg had significantly increased risk for death (hazard ratio, 1.35), compared with patients whose systolic BP was 140 to159 mm Hg (the reference standard). In contrast, those with systolic BP 160 mm Hg were not at higher risk for death (HR, 0.97).

Comment: In this population-based prospective study of very old people, "normal" systolic blood pressure was associated with increased mortality, but mild-to-moderate systolic hypertension was not. No randomized trials have established whether drug therapy reduces morbidity or mortality in mildly hypertensive very old people. Although this observational study is no substitute for a randomized trial, its findings suggest that we should think twice before initiating drug therapy for mildly hypertensive people in this age group.

— Allan S. Brett, MD

Published in Journal Watch General Medicine June 27, 2006

Citation(s):

Rastas S et al. Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc 2006 Jun; 54:912-8.

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