Blood pressure trends and mortality

Poortvliet, Rosalinde K.E.; Ruijter, Wouter de; Craen, Anton J. M. de; Mooijaart, Simon P.; Westendorp, Rudi G.J.; Assendelft, W.J.J.; Gussekloo, Jacobijn; Blom, Jeanet W.

doi:10.1097/hjh.0b013e32835aa351

Cited by 49 publications

(39 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In several of these studies, a sharply attenuated or even inverse association between BP and cardiovascular risk was found in the highest age groups. [28][29][30][31][32] The age at which the association inversed in these studies is not unequivocal, but seems to be in the range of 75 to 85 years. In addition, a J-shaped association of diastolic BP with mortality and myocardial infarction was found in patients with cardiovascular disease, suggesting that excessive reduction of diastolic BP in these patients should be avoided.…”

Section: Risk Of Cardiovascular Events and Mortalitymentioning

confidence: 87%

“…Indeed, the majority of the latter studies explicitly included older persons with high levels of comorbidity, frailty, activities of daily living dependency, or cognitive impairment. [28][29][30][31][32] However, no study has systematically addressed the impact of general health status in the aggregate of the earlier cohort studies in an analysis similar to that performed by the Prospective Studies Collaboration. A second question that must be addressed is whether it would be possible to pinpoint the most appropriate way to assess general health/frailty in this particular context.…”

Section: Risk Of Cardiovascular Events and Mortalitymentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Hypertension in the Oldest Old

et al. 2014

View full text Add to dashboard Cite

A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

show abstract

Section: Risk Of Cardiovascular Events and Mortalitymentioning

confidence: 87%

Section: Risk Of Cardiovascular Events and Mortalitymentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

View full text Add to dashboard Cite

show abstract

“…40 In the Leiden 85-plus Study, we previously showed that in the oldest old, declines in blood pressure during followup associate with increased mortality risk. 6,41 A limitation of our study is that information on cardiac output and cerebral perfusion is not available. Echocardiography was only performed in a convenience sample of 90 year olds, and unfortunately not at baseline.…”

Section: Resultsmentioning

confidence: 99%

NT-proBNP, blood pressure, and cognitive decline in the oldest old

et al. 2014

View full text Add to dashboard Cite

Objective: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old.Methods: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive function (Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years.Results: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p 5 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p 5 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p 5 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p , 0.001) and a 0.49-point-steeper decline in MMSE score per year (p , 0.001) compared with subjects in the other categories. Conclusions:In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction. Cardiovascular diseases, such as myocardial infarction, generalized atherosclerosis, and stroke have been associated with increased dementia risk and cognitive decline.1-4 Hypertension, however, is only a risk factor for dementia when present in middle age, whereas most studies show that dementia and cognitive decline in the oldest old associate with lower blood pressures. 5In the oldest old, blood pressures decrease over time, 6,7 and stronger declines are related to the presence of dementia and cognitive decline. 8,9 One possible explanation for the blood pressure decline in the oldest old might be the increasing prevalence of (subclinical) congestive heart failure.10 Despite this dynamic correlation between blood pressure and cardiac function in relation to cognitive function in old age, previous studies have mainly focused on either the association of blood pressure or cardiac function with cognitive impairment.Congestive heart failure has been associated with an increased risk of cognitive impairment. 11-13A frequently used serum marker of heart failure is the N-terminal pro-brain natriuretic peptide (NT-proBNP), the inactive fragment of the proBNP hormone. 14 NT-proBNP has proven to be a quantitative marker of acute heart failure in clinical practice, with high sensitivity and reasonable specificity, 15 although elevated NT-proBNP levels are not specific for heart failure in the general population. Several studies have shown that higher NT-proBNP levels associate with lower cognitive function. 16,17 However, the relation among NT-proBNP levels, blood pressure, and cognitive f...

show abstract

“…For instance, up to about age 70 years systolic blood pressure (SBP) increases continuously with age (23) and high SBP is a well-recognised risk factor for CVD and associated mortality (24)(25)(26) . At higher ages, however, SBP decreases rather than increases with age (23) and higher blood pressure becomes protective in terms of all-cause mortality and cognition, whereas low SBP confers increased risks for mortality, cognitive impairment and disability (17,(27)(28)(29)(30)(31) . Similarly, short peripheral blood telomere length (TL) is recognised as a risk factor for both mortality and (multi-) morbidity (32)(33)(34)(35)(36)(37) .…”

Section: Use Of Birth Cohorts For Biomarker Validationmentioning

confidence: 99%

“…However, the general pattern remained even for participants not on antihypertensive medication and after adjustment for survivor bias (23) . Moreover, low SBP predicted increased mortality in 90-year olds without heart failure, defined by low levels of N-terminal prohormone of brain natriuretic peptide (30,41) . Life history cohorts are the ideal test bed to establish the age dependency of candidate biomarkers of ageing.…”

Section: Use Of Birth Cohorts For Biomarker Validationmentioning

confidence: 99%

Biomarkers of healthy ageing: expectations and validation

Martin-Ruiz

Zglinicki

2014

Proc. Nutr. Soc.

View full text Add to dashboard Cite

The challenge of devising a set of biomarkers capable of measuring the ageing rate in human subjects was articulated long ago. In recent years, progress in the basic biology of ageing suggests the realistic possibility of preventive or restaurative interventions that may extend healthy lifespan in mammals including human subjects. Specifically, frailty is being increasingly recognised as a clinically relevant syndrome that may be therapeutically addressed. This greatly enhances the need for sensitive and specific biomarkers of healthy ageing that are validated in both experimental animals and, importantly, in human subjects over the whole age range. Here, we will discuss the present challenges and requirements for biomarker validation in human subjects. We propose the central requirements for a validated biomarker of healthy ageing as: (i) better predictive power than chronological age for multiple dimensions of ageing; (ii) identification of the age range in which the marker is informative; (iii) establishment of sensitivity/specificity as indicators of its predictive power at the level of the individual; (iv) minimisation of methodological variation between laboratories.

show abstract

Blood pressure trends and mortality

Abstract: In very old age, both decreasing trend in SBP over the previous 5 years and the current SBP value independently contribute to prediction of all-cause mortality. Therefore, in individual patients, all available preceding SBP measurements should be taken into account.

Cited by 49 publications

References 30 publications

Treatment of Hypertension in the Oldest Old

Treatment of Hypertension in the Oldest Old

NT-proBNP, blood pressure, and cognitive decline in the oldest old

Biomarkers of healthy ageing: expectations and validation

Contact Info

Product

Resources

About