Lower risk of adverse outcomes secondary to hypertension observed at higher ages in elderly

1. When comparing cohorts of patients above and below 75 years of age, hypertension had a greater association with mortality, cardio-kidney composite events, and overt dementia in patients aged 45-74 years.

Evidence Rating Level: 2 (Good)

Blood pressure (BP) gets increasingly higher as people begin aging. Not only does hypertension increase, but other risk factors for high BP such as diabetes also have higher prevalence in older individuals. High BP is typically treated with antihypertensives; however, it is important to establish the point where this intervention is needed. The study sought to establish systolic blood pressure (SBP) targets for aging individuals, by comparing negative health outcomes to a lower-aged representative cohort. took place from July to December 2021 using data provided by the National Health Information Database. The participants were classified based on their age range. Included were 24 527 oldest-old (mean age, 87.2; 40.2% men), 271 943 middle-old (mean age, 78.5 years; 39.3% men), 94 918 young-old (mean age, 69.3 years; 44.4% men) and 164 110 middle-aged (mean age, 56.0 years; 51.4%) individuals. The mortality differences between SBP levels were estimated to be -0.9 (95% CI, -6.5 to 5.0) in the oldest-old group, 1.6 (95% CI, 0.6 to 2.6) in the middle-old group, and 1.2 (95% CI, 0.7 to 1.7) in the middle-aged groups all per 1000 person-years. In older participants, the J-curve was different for men and women (P = 0.014 for interaction), whereas in the younger participants, the association did not differ between men and women (P = 0.50 for interaction). When considering risk factors, there was a left shift for association with SBP and cardio or kidney risks for both older (P = 0.001 for interaction) and younger (P = 0.010 for interaction) participants. Overall, BP treatments require a more individualized approach with less aggressive lowering treatments in very old patients or those with few risk factors, however, more strict control in patients with several risk factors, regardless of age.

Click to read the study in PLOSONE

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