Journal
HYPERTENSION
Volume 66, Issue 4, Pages 865-873Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.115.05800
Keywords
aged; aged 80 and over; cardiovascular diseases; home; blood pressure monitoring; hypertension
Categories
Funding
- European Union [IHEALTH-F7-2011-278249 EU-MASCARA, HEALTH-F7-305507 HOMAGE]
- European Union (European Research Council Advanced Research Grant) [294713 EPLORE]
- Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium [G.0881.13, G.088013 N]
- Ministry of Education, Culture, Sports, Science, and Technology, Japan [23249036, 23390171, 24390084, 24591060, 24790654, 25253059, 25461083, 25461205, 25860156, 26282200, 26860093]
- Japan Society for the Promotion of Science (JSPS) [25.7756, 25.9328, 26.857]
- Japan Arteriosclerosis Prevention Fund
- Intramural Research Fund for Cardiovascular Diseases of National Cerebral and Cardiovascular Center [22-4-5]
- Health Labor Sciences Research Grant from the Ministry of Health, Labour, and Welfare [H26-Junkankitou [Seisaku]-Ippan-001]
- Scheme to Revitalize Agriculture and Fisheries in Disaster Area through Deploying Highly Advanced Technology from the Ministry of Agriculture, Forestry and Fisheries, Japan [NouEi 2-02]
- Health Sciences Research Grant for Health Service from the Ministry of Health, Labor and Welfare, Japan [H21-Choju-Ippan-001]
- Department of Internal Medicine of the Hospital Italiano de Buenos Aires (Capital Federal, Argentina)
- Grants-in-Aid for Scientific Research [25253059] Funding Source: KAKEN
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To generate outcome-driven thresholds for home blood pressure (BP) in the elderly, we analyzed 375 octogenarians (60.3% women; 83.0 years [mean]) enrolled in the International Database on home BP in relation to cardiovascular outcome. Over 5.5 years (median), 155 participants died, 76 from cardiovascular causes, whereas 104, 55, 36, and 51 experienced a cardiovascular, cardiac, coronary, or cerebrovascular event, respectively. In 202 untreated participants, home diastolic in the lowest fifth of the distribution (65.1 mmHg) compared with the multivariable-adjusted average risk was associated with increased risk of cardiovascular mortality and morbidity (hazard ratios [HRs], 1.96; P0.022), whereas the HR for cardiovascular mortality in the top fifth (82.0 mmHg) was 0.37 (P=0.034). Among 173 participants treated for hypertension, the HR for total mortality in the lowest fifth of systolic home BP (<126.9 mmHg) was 2.09 (P=0.020). In further analyses of home BP as continuous variable (per 1-SD increment), higher diastolic BP predicted lower cardiovascular mortality and morbidity and cardiac and coronary risk (HR0.65; P0.039) in untreated participants. In those treated, cardiovascular morbidity was curvilinearly associated with systolic home BP with nadir at 148.6 mmHg and with a 1.45 HR (P=0.046) for a 1-SD decrease below this threshold. In conclusion, in untreated octogenarians, systolic home BP 152.4 and diastolic BP 65.1 mmHg entails increased cardiovascular risk, whereas diastolic home BP 82 mmHg minimizes risk. In those treated, systolic home BP <126.9 mmHg was associated with increased total mortality with lowest risk at 148.6 mmHg.
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