NOT TOO LOW BP FOR ELDERLY

Low Systolic Blood Pressure Is Linked to Higher Mortality in the Elderly

NEW YORK (Reuters Health) Oct 23 - A paper in the Journal of the American Geriatrics Society for October suggests that lower systolic blood pressure is associated with higher mortality in people aged 85 years and older.

In a population-based cohort study, Lena Molander and colleagues from Umea University, Sweden, examined the association between blood pressure and mortality using data on 348 elderly individuals living in one urban and five rural municipalities in northern Sweden. These subjects comprised half of all individuals 85 years of age in those communities, all of those aged 90 years, and all aged 95 years or older.

Compared to individuals with systolic blood pressure (SBP) above 120 mmHg, those with SBP at or below 120 mmHg had a significantly higher prevalence of heart failure and significantly reduced ability to perform activities of daily living. In addition, subjects with SBP at or below 120 mm Hg had lower Mini-Mental State Examination scores compared to those with SBP above 140 mmHg and a higher prevalence of dementia compared to those with SBP above 160 mmHg.

At 4 years of follow-up, 81.4% of those with SBP of 120 mm Hg or less had died, versus 46.6% of those with SBP of 141 to 160 mm Hg (p <>

The 4-year mortality rate was 56.9%. On Cox regression analyses, SBP less than or equal to 120 mm Hg was correlated with greater 4-year all-cause mortality alone and after controlling for health status. The presence of hypertension was associated with lower mortality, the authors found.

"High blood pressure is a very common condition, especially in the older population, and the number of individuals receiving antihypertensive medication is substantial," Dr. Molander said in an email interview with Reuters Health. "Our findings, which are in accordance with previous studies, imply the need of an expanded discussion about if and when high blood pressure should be treated in the oldest, and also a need of further studies on antihypertensive treatment and its effect on morbidity and mortality in this age group specifically."

"We wish to emphasize that, despite the title of the article, low diastolic blood pressure was also associated with an increased 4-year mortality," Molander said. "The association with systolic blood pressure was, however, stronger and we decided to put our emphasis on this result."