Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
- Authors
- Song, Myung-Sun; Choi, Yeon joo; Kim, Hyunjin; Nam, Myung Ji; Lee, Chung-woo; Han, Kyungdo; Jung, Jin-Hyung; Park, Yong-Gyu; Kim, Do-Hoon; Park, Joo-Hyun
- Issue Date
- Nov-2021
- Publisher
- BioMed Central
- Keywords
- Elderly; Hypertension; Blood pressure; Ischemic stroke; Myocardial infarction; Mortality
- Citation
- BMC Geriatrics, v.21, no.1
- Indexed
- SCIE
SSCI
SCOPUS
- Journal Title
- BMC Geriatrics
- Volume
- 21
- Number
- 1
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/54748
- DOI
- 10.1186/s12877-021-02570-7
- ISSN
- 1471-2318
1471-2318
- Abstract
- Background
In the very elderly, “the lower the better” hypothesis has constantly been contradicted by randomized control trials and various cohort studies, but inconsistency in results led to unclear blood pressure treatment targets. This study aimed to assess the relationship between baseline blood pressure (BP) and ischemic stroke, myocardial infarction, and all-cause mortality in very elderly people treated for hypertension.
Methods
This large population-based retrospective cohort study was based on the national claims database of the Korean National Health Insurance System, which covers the entire Korean population. 374,250 participants aged ≥ 75 years taking antihypertensive agents were recruited, excluding patients with a history of previous ischemic stroke or myocardial infarction.
Results
Systolic BP (SBP) followed a J curve for ischemic stroke and a U curve for all-cause mortality, with nadir ranges of 120 to 129 mmHg and 140 to 149 mmHg, respectively. While increasing diastolic BP (DBP) generally resulted in higher HRs for ischemic stroke, HRs for myocardial infarction and all-cause mortality significantly increased only when DBP was ≥ 80 mmHg and ≥ 90 mmHg, respectively. The SBP/DBP combination analysis showed that even with SBP < 130 mmHg, higher DBP ≥ 90 mmHg had higher HRs for all three outcomes compared to the reference group (130 to 149 / < 80 mmHg).
Conclusions
There were no further benefits or even harm below certain BP levels for ischemic stroke, myocardial infarction, and all-cause mortality in very elderly hypertensive patients.
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Collections - 2. Clinical Science > Department of Family Medicine > 1. Journal Articles
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