Prospective Study of the Effect of Blood Pressure on Renal Function in Old Age

Abstract

High BP is associated with decline of renal function. Whether this is true for very old people largely is unknown. Therefore, this study assessed the effect of BP on creatinine clearance over time in very old participants. A total of 550 inhabitants (34% men) of Leiden, The Netherlands, were enrolled in a population-based study at their 85th birthday and followed until death or age 90. BP was measured twice at baseline and at age 90 yr. Creatinine clearance was estimated annually (Cockcroft-Gault formula). The mean creatinine clearance at baseline was 45.4 ml/min (SD 11.5). Systolic BP was not associated with changes in creatinine clearance during follow-up. Those with diastolic BP (DBP) <70 mmHg had an accelerated decline of creatinine clearance ( In contrast with younger populations, in the oldest individuals, the association among high BP, mortality, and renal function is not straightforward. The available data suggest that BP lowering above 80 yr does not lower overall mortality (4,5). Data on the effect of BP on morbidity such as renal function are relatively scarce in the oldest individuals (6 -8). One longitudinal report associated BP and renal function in a considerable group of very old Japanese individuals (7). In that report, high BP was related to an excess decline of serum creatinine. However, an important drawback was the use of serum creatinine for estimation of renal function. In addition, selection bias could have been induced as a result of exclusion of 40% of the participants, who did not attend the reexamination after 3 yr.Although BP lowering in individuals over 80 yr might not lower mortality, it is unknown whether a high BP might be deleterious for renal function. To investigate whether high BP still is a risk factor for decline in renal function in the oldest individuals, we prospectively studied the effect of BP on changes of creatinine clearance over time in a population-based study of the general population of the oldest individuals. Materials and Methods Study PopulationThe Leiden 85-Plus Study is a prospective, population-based study of all 85-yr-old inhabitants of Leiden, The Netherlands. The study design and characteristics of the cohort were described in detail previously (9,10). In short, between September 1997 and September 1999, all 705 members of the 1912 to 1914 birth cohort in the city of Leiden were asked to participate in the month after their 85th birthday. There were no selection criteria related to health or demographic characteristics. Participants were followed until death or the age of 90. At baseline and yearly thereafter, 85-yr-old participants were visited at their place of residence. During these visits, participants were weighed, BP was measured, a venous blood sample was drawn, an electrocardiogram was recorded, and face-to-face interviews and performance tests were conducted. Information on the medical history was obtained by standardized interviews of the participants' treating physicians. In addition, information on the use of medication was obtained from th...

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