Declining blood pressure and intensification of blood pressure management among people over 80 years

Ravindrarajah, Rathi; Dregan, Alexandru; Hazra, Nisha C.; Hamada, Shota; Jackson, Stephen; Gulliford, Martin

doi:10.1097/hjh.0000000000001291

Cited by 11 publications

(8 citation statements)

References 43 publications

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“…Primary care EHRs include data concerning the results of clinical and laboratory tests and records of lifestyle behaviors. Analysis of these data can provide aggregate results that are consistent with estimates from national survey data for variables including smoking [24] and blood pressure [25,26]. Test results are not regularly recorded over time as might be expected in a clinical trial; instead there is risk of confounding by indication because physicians order tests when there is a reason to do so.…”

Section: Characteristics Of Primary Care Ehr Datamentioning

confidence: 55%

Developing the role of electronic health records in economic evaluation

2019

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Section: Characteristics Of Primary Care Ehr Datamentioning

confidence: 55%

Developing the role of electronic health records in economic evaluation

2019

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“…The proportion of treated patients with SBP <110 mm Hg increased with frailty level, which might indicate over-treatment in some cases. Longitudinal analysis of participants’ blood pressure records revealed a secular decline in SBP24 but in participants who die, there is an accelerated decline in SBP in the final 24 months of life. These last months of life are associated with greatly increased odds of low SBP recordings.…”

Section: Discussionmentioning

confidence: 95%

“…We compared SBP trajectories of participants who died with those who survived to the end of the study but associations might be diminished if the surviving patients were also nearing the end of their lives. During the period of study, there were changes in antihypertensive drug utilisation in this population with declining use of diuretics and increasing use of drugs acting on the renin-angiotensin system and calcium channel blockers 24. There were also secular declines in systolic blood pressure24 and mortality 35.…”

Section: Discussionmentioning

confidence: 99%

“…During the period of study, there were changes in antihypertensive drug utilisation in this population with declining use of diuretics and increasing use of drugs acting on the renin-angiotensin system and calcium channel blockers 24. There were also secular declines in systolic blood pressure24 and mortality 35. More people are living to older ages but often with greater comorbidity 36.…”

Section: Discussionmentioning

confidence: 99%

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Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age

et al. 2017

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BACKGROUND:Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with allcause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. METHODS:A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportionalhazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. RESULTS:During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP <110 mm Hg. In fit women, mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP <110 mm Hg. For women with severe frailty, rates were 16.8, 25.2, and 39.6, respectively. SBP trajectories showed an accelerated decline in the last 2 years of life. The relative odds of SBP <120 mm Hg were higher in the last 3 months of life than 5 years previously in both treated (odds ratio, 6.06; 95% confidence interval, 5.40-6.81) and untreated (odds ratio, 6.31; 95% confidence interval, 5.30-7.52) patients. There was no evidence of intensification of antihypertensive therapy in the final 2 years of life. CONCLUSIONS:A terminal decline of SBP in the final 2 years of life suggests that nonrandomized epidemiological associations of low SBP with higher mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life. 2358 B lood pressure increases with age, and older people have a higher prevalence of hypertension. 1,2 Elevated systolic blood pressure (SBP) may be the most important risk factor for cardiovascular disease in older people. 3 Recently, several large clinical trials 4-9 have suggested that use of antihypertensive medications to lower blood pressure may reduce cardiovascular events and mortality in older adults. In HYVET (Hypertension in the Very Elderly Trial) 6 of antihypertensive therapy >80 years of age, lowering blood pressure was associated with 30% reduction in stroke, 21% reduction in all-cause mortality, and 64% reduction in heart failure. In SPRINT (Systolic Blood Pressure Intervention Trial), 7 in people ≥75 years of age, management of SBP to a target of <120 mm Hg was associated with 34% reduction in cardiovascular events and 33% reduction in all-cause mortality. Th...

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“…That study showed that hypertension treatment intensified between 2001 and 2014. Blood pressure values decreased in both treated and untreated participants, with a substantial increase in the proportion of patients achieving conventional blood pressure targets among octogenarians 14 .…”

Section: Discussionmentioning

confidence: 97%

Ten-year trends of hypertension treatment and control rate in Korea

Kim

Choi

et al. 2021

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We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.

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Declining blood pressure and intensification of blood pressure management among people over 80 years

Cited by 11 publications

References 43 publications

Developing the role of electronic health records in economic evaluation

Developing the role of electronic health records in economic evaluation

Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age

Ten-year trends of hypertension treatment and control rate in Korea

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