Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
| Autor: | Joo-Hyun Park, Do Hoon Kim, Yeon joo Choi, Myung-Sun Song, Chung-Woo Lee, Kyungdo Han, Yong Gyu Park, Jin-Hyung Jung, Hyun Jin Kim, Myung Ji Nam |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Diastole Brain Ischemia law.invention Cohort Studies Population based cohort Elderly Randomized controlled trial Risk Factors law Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Mortality Antihypertensive Agents Aged Retrospective Studies Ischemic stroke business.industry Research RC952-954.6 Retrospective cohort study medicine.disease Stroke Blood pressure Geriatrics Hypertension Cardiology Geriatrics and Gerontology business Cohort study |
| Zdroj: | BMC Geriatrics, Vol 21, Iss 1, Pp 1-8 (2021) BMC Geriatrics |
| ISSN: | 1471-2318 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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