Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication

Abstract

Introduction The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication. Methods US adults ≥45 years of age taking antihypertensive medication enrolled in the REGARDS study were categorized into 3 age groups: 55–64, 65–74 and ≥75 years old and baseline on-treatment SBP levels. Our primary analyses focused on incident cardiovascular disease (CVD) (n=9,787) and all-cause mortality (n=13,948). Results During follow-up, 530 (5.4%) participants had CVD events and 2095 (15%) participants died. After multivariable adjustment among participants ≥75, the incidence of CVD per 1,000 person-years (95% confidence interval) was 16.9 (11.1–25.7), 13.4 (9.2–19.7), 11.6 (7.6–17.7), 17.8 (11.2–27.5) and 36.7 (26.6–50.8) at SBP levels of <120, 120–129, 130–139, 140–149, and ≥150mmHg, respectively. For the same SBP categories, the adjusted CVD incidence rates were 9.3 (7.2–12.0), 10.0 (8.1–12.3), 9.4 (7.5–11.8), 14.0 (11.0–17.8), and 16.4 (12.5–21.4), respectively, among participants 55–64 years, and 16.5 (13.6–21.5), 17.4 (14.8–20.6), 19.2 (16.4–22.5), 22.3 (18.6–26.9), and 27.6 (22.7–33.4), respectively, for participants 65–74 years. Among participants aged 55–64 and 65–74 years, a linear association was present between higher SBP categories and all-cause mortality risk (each p-trend<0.001). In contrast, for participants ≥75 years no association was present between SBP and all-cause mortality (p-trend=0.319). No association was observed between SBP and falls among participants in all age groups. Conclusions Among adults aged ≥55 taking antihypertensive medication, SBP between 120–139mmHg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes.

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…Numerous randomized clinical trials in hypertensive adults have provided evidence that antihypertensive treatment reduces the risk of death and major CV events such as stroke, myocardial infarction, heart failure and renal failure and improves life expectancy (166)(167)(168)(169)(170).…”

Systolic Blood Pressure Levels Associated with Cardiovascular Events and All-cause Mortality: Results from the REGARDS Study

“…For persons aged 65 to 74 years, there was a significant increased incidence of cardiovascular disease and of coronary heart disease at systolic blood pressure levels of 150 mm Hg and higher, of stroke at systolic blood pressure levels of 130 mm Hg and higher, and of allcause mortality at systolic blood pressure levels of 140 mm Hg and higher [1]. In this age group, systolic blood pressure was not associated with recurrent falls [1].…”

“…For persons aged 55 to 64 years, a systolic blood pressure below 140 mm Hg was associated with the lowest incidence of cardiovascular disease, coronary heart disease, stroke, and all-cause mortality, with numerically the highest risk at a systolic blood pressure of 140 to 149 mm Hg, and especially for a systolic blood pressure of 150 mm Hg and higher [1]. The risk of recurrent falls was also increased at systolic blood pressure levels of 150 mm Hg and higher [1].…”

“…For persons aged 75 years and older, there was a significant increased incidence of cardiovascular disease, coronary heart disease, and stroke at systolic blood pressure levels of 140 mm Hg and higher [1]. The incidence of cardiovascular disease, coronary heart disease, stroke, all-cause mortality, and recurrent falls was significantly increased at systolic blood pressure levels below 120 mm Hg [1].…”

“…The risk of recurrent falls was also increased at systolic blood pressure levels of 150 mm Hg and higher [1].…”