Association Between Blood Pressure and Mortality in a Spanish Cohort of Persons Aged 65 Years or Over: A Dynamic Model

Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population

“…11 Also, another long cohort study of 1,560 Spanish adults aged ≥65 years reported a U-shaped relationship between SBP (as a time-dependent covariate) and all-cause mortality, with a nadir at the value of 147 mmHg; also, the relationship between DBP (as a time-dependent covariate) and mortality was reverse J-shaped, in which higher DBP had survival advantage below the value of 80 mmHg and it had no bearing on mortality over that value. 12 Not only some degrees of HTN are suggested to have survival advantage or at least no survival disadvantage, the benefits of tight blood pressure control have also been suspected in advanced age. The pooled results of a meta-analysis of eight RCTs (total n: 6,701) involving hypertensive patients aged ≥80 years showed that antihypertensive treatment did not yield any significantly reduced all-cause, CV, coronary, or stroke death compared to either placebo or no treatment (Supplemental Figure S3); in addition, the few trials showing reduced mortality were the ones with the lowest intensity of therapy and the least BP reductions.…”

“…However, albeit counterintuitive, some conventional CV risk factors such as elevated body mass index (BMI), serum cholesterol, and blood pressure (BP) are reportedly linked to lower – instead of higher – risk of death among the elderly. 4–12 The phenomenon of established CV risk factors having a markedly different and even opposite predictive pattern is termed “reverse epidemiology” or “risk factor paradox” and it is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. 13–15 These observations call into question the practice of extrapolating CV risk factor targets derived from the general population to the getiartic population.…”

Walking speed and high blood pressure mortality risk in a Spanish elderly population

“…[1][2][3] In persons aged 65 and over, the evidence suggests that hypertension continues to be a prognostic factor, [3][4][5][6][7][8] although some studies support a U-or J-shaped relationship, [9][10][11][12][13] or even an inverse association, 14 between both systolic (SBP) and diastolic blood pressure (DBP) and mortality.…”

Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study

“…Our study has several strengths, including its setting in Asia and large sample size. The follow-up period, 7 years, is longer than many previous observational cohort studies linking BP with mortality among older adults (Beddhu et al, 2018; Odden et al, 2012; Protogerou et al, 2007; Streit et al, 2018; Tervahauta et al, 1994), although some studies do have longer follow-up periods (Gutierrez-Misis et al, 2013; Masoli et al, 2020; Merlo et al, 1996; Ogliari et al, 2015). We adjusted for a wide range of confounders, many of which—including sleep duration and psychosocial factors—are seldom considered among previous studies.…”

“…Population-based observational cohort studies that focus exclusively on older adults have reported a J- or U-shaped relationship of blood pressure (BP) with mortality risk, with higher risk of mortality at lower and upper extremes of BP (Beddhu et al, 2018; Gutierrez-Misis et al, 2013; Masoli et al, 2020; Merlo et al, 1996; Ogliari et al, 2015; Protogerou et al, 2007; Tervahauta et al, 1994). While informative, these observational studies have a major limitation—they often do not consider confounders beyond demographic characteristics and physical health or chronic disease status.…”