Dataset Information

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

ABSTRACT: 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.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=9787) and all-cause mortality (n=13,948).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 1000 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 ? 150 mmHg, 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.Among adults aged ? 55 taking antihypertensive medication, SBP between 120 and 139 mmHg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes.

SUBMITTER: Banach M

PROVIDER: S-EPMC4144437 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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

Banach Maciej M Bromfield Samantha S Howard George G Howard Virginia J VJ Zanchetti Alberto A Aronow Wilbert S WS Ahmed Ali A Safford Monika M MM Muntner Paul P

International journal of cardiology 20140722 1

<h4>Introduction</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 25085381

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Project description:Rationale and objectiveAlthough low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. This study aimed to evaluate the associations between variability in eGFR and the risk of CVD events and all-cause mortality.Study designLongitudinal analysis of clinical trial participants.Settings and participants7,520 Systolic Blood Pressure Intervention Trial (SPRINT) participants ≥50 year of age with 1 or more CVD risk factors.PredictorseGFR variability, estimated by the coefficient of variation of eGFR assessments at the 6th, 12th, and 18-month study visits.OutcomesThe SPRINT primary CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and all-cause mortality from month 18 to the end of follow-up.Analytical approachCox models were used to evaluate associations between eGFR variability and CVD outcomes and all-cause mortality. Models were adjusted for demographics, randomization arm, CVD risk factors, albuminuria, and eGFR at month 18.ResultsMean age was 68 ± 9 years; 65% were men; and 58% were White. The mean eGFR was 73 ± 21 (SD) mL/min/1.73 m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. Greater eGFR variability was associated with higher risk for all-cause mortality (hazard ratio [HR] per 1 SD greater variability, 1.29; 95% CI, 1.14-1.45) but not CVD events (HR, 1.05; 95% CI, 0.95-1.16) after adjusting for albuminuria, eGFR, and other CVD risk factors. Associations were similar when stratified by treatment arm and by baseline CKD status, when accounting for concurrent systolic blood pressure changes, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic medications during follow up.LimitationsPersons with diabetes and proteinuria > 1 g/d were excluded.ConclusionsIn trial participants at high risk for CVD, greater eGFR variability was independently associated with all-cause mortality but not CVD events.

Project description:BackgroundBlood pressure (BP) management in frail older people is challenging. An randomised controlled trial of largely non-frail older people found cardiovascular and mortality benefit with systolic (S) BP target <120 mmHg. However, all-cause mortality by attained BP in routine care in frail adults aged above 75 is unclear.ObjectivesTo estimate observational associations between baseline BP and mortality/cardiovascular outcomes in a primary-care population aged above 75, stratified by frailty.MethodsProspective observational analysis using electronic health records (clinical practice research datalink, n = 415,980). We tested BP associations with cardiovascular events and mortality using competing and Cox proportional-hazards models respectively (follow-up ≤10 years), stratified by baseline electronic frailty index (eFI: fit (non-frail), mild, moderate, severe frailty), with sensitivity analyses on co-morbidity, cardiovascular risk and BP trajectory.ResultsRisks of cardiovascular outcomes increased with SBPs >150 mmHg. Associations with mortality varied between non-frail <85 and frail 75-84-year-olds and all above 85 years. SBPs above the 130-139-mmHg reference were associated with lower mortality risk, particularly in moderate to severe frailty or above 85 years (e.g. 75-84 years: 150-159 mmHg Hazard Ratio (HR) mortality compared to 130-139: non-frail HR = 0.94, 0.92-0.97; moderate/severe frailty HR = 0.84, 0.77-0.92). SBP <130 mmHg and Diastolic(D)BP <80 mmHg were consistently associated with excess mortality, independent of BP trajectory toward the end of life.ConclusionsIn representative primary-care patients aged ≥75, BP <130/80 was associated with excess mortality. Hypertension was not associated with increased mortality at ages above 85 or at ages 75-84 with moderate/severe frailty, perhaps due to complexities of co-existing morbidities. The priority given to aggressive BP reduction in frail older people requires further evaluation.

Dataset Information

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

Publications

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

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