Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study

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 basel...

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Autores principales:	Myung-Sun Song, Yeon joo Choi, Hyunjin Kim, Myung Ji Nam, Chung-woo Lee, Kyungdo Han, Jin-Hyung Jung, Yong-Gyu Park, Do-Hoon Kim, Joo-Hyun Park
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Elderly Hypertension Blood pressure Ischemic stroke Myocardial infarction Mortality Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/a2571eefe43a4da094322e0e5df824aa
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spelling	oai:doaj.org-article:a2571eefe43a4da094322e0e5df824aa2021-11-07T12:16:27ZRelationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study10.1186/s12877-021-02570-71471-2318https://doaj.org/article/a2571eefe43a4da094322e0e5df824aa2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12877-021-02570-7https://doaj.org/toc/1471-2318Abstract 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.Myung-Sun SongYeon joo ChoiHyunjin KimMyung Ji NamChung-woo LeeKyungdo HanJin-Hyung JungYong-Gyu ParkDo-Hoon KimJoo-Hyun ParkBMCarticleElderlyHypertensionBlood pressureIschemic strokeMyocardial infarctionMortalityGeriatricsRC952-954.6ENBMC Geriatrics, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Elderly Hypertension Blood pressure Ischemic stroke Myocardial infarction Mortality Geriatrics RC952-954.6
spellingShingle	Elderly Hypertension Blood pressure Ischemic stroke Myocardial infarction Mortality Geriatrics RC952-954.6 Myung-Sun Song Yeon joo Choi Hyunjin Kim Myung Ji Nam Chung-woo Lee Kyungdo Han Jin-Hyung Jung Yong-Gyu Park Do-Hoon Kim Joo-Hyun Park Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
description	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.
format	article
author	Myung-Sun Song Yeon joo Choi Hyunjin Kim Myung Ji Nam Chung-woo Lee Kyungdo Han Jin-Hyung Jung Yong-Gyu Park Do-Hoon Kim Joo-Hyun Park
author_facet	Myung-Sun Song Yeon joo Choi Hyunjin Kim Myung Ji Nam Chung-woo Lee Kyungdo Han Jin-Hyung Jung Yong-Gyu Park Do-Hoon Kim Joo-Hyun Park
author_sort	Myung-Sun Song
title	Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
title_short	Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
title_full	Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
title_fullStr	Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
title_full_unstemmed	Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
title_sort	relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a2571eefe43a4da094322e0e5df824aa
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Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study

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