Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication

被引：50

作者：

Banach, Maciej ^{[1
]}

Bromfield, Samantha ^{[2
]}

Howard, George ^{[3
]}

Howard, Virginia J. ^{[2
]}

Zanchetti, Alberto ^{[4
]}

Aronow, Wilbert S. ^{[5
]}

Ahmed, Ali ^{[6
,7
]}

Safford, Monika M. ^{[8
]}

Muntner, Paul ^{[2
]}

机构：

[1] Med Univ Lodz, Dept Hypertens, Chair Nephrol & Hypertens, PL-90549 Lodz, Poland

[2] Univ Alabama Birmingham, Sch Publ Hlth, Dept Epidemiol, Birmingham, AL 35294 USA

[3] Univ Alabama Birmingham, Sch Publ Hlth, Dept Biostat, Birmingham, AL 35294 USA

[4] Univ Milan, Ist Auxol Italiano, Milan, Italy

[5] New York Med Coll, Dept Med, Westchester Med Ctr, Div Cardiol, Valhalla, NY 10595 USA

[6] Univ Alabama Birmingham, Birmingham, AL USA

[7] Vet Affairs Med Ctr, Birmingham, AL USA

[8] Univ Alabama Birmingham, Sch Med, Div Prevent Med, Birmingham, AL USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2014年 / 176卷 / 01期

基金：

美国国家卫生研究院;

关键词：

Blood pressure; Elderly; Hypertension; Mortality; Stroke; Coronary heart disease; EXPERT CONSENSUS DOCUMENT; HEART-DISEASE; TASK-FORCE; HYPERTENSION; STROKE; THERAPY;

D O I：

10.1016/j.ijcard.2014.07.067

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Introduction: The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication. Methods: US adults >= 45 years of age taking antihypertensive medication enrolled in the REGARDS study were categorized into 3 age groups: 55-64, 65-74 and >= 75 years old and baseline on-treatment SBP levels. Our primary analyses focused on incident cardiovascular disease (CVD) (n = 9787) and all-cause mortality (n= 13,948). Results: During follow-up, 530 (5.4%) participants had CVD events and 2095 (15%) participants died. After multivariable adjustment among participants >= 75, the incidence of CVD per 1000 person-years (95% confidence interval) was 16.9 (11.1-25.7), 13.4 (9.2-19.7), 11.6 (7.6-17.7), 17.8 (11.2-27.5) and 36.7 (26.6-50.8) at SBP levels of <120, 120-129, 130-139, 140-149, and >= 150mm Hg, respectively. For the same SBP categories, the adjusted CVD incidence rates were 9.3 (7.2-12.0), 10.0 (8.1-12.3), 9.4 (7.5-11.8), 14.0 (11.0-17.8), and 16.4 (12.5-21.4), respectively, among participants 55-64 years, and 16.5 (13.6-21.5), 17.4 (14.8-20.6), 19.2 (16.4-22.5), 22.3 (18.6-26.9), and 27.6 (22.7-33.4), respectively, for participants 65-74 years. Among participants aged 55-64 and 65-74 years, a linear association was present between higher SBP categories and all-cause mortality risk (each p-trend <0.001). In contrast, for participants >= 75 years no association was present between SBP and all-cause mortality (p-trend = 0.319). No association was observed between SBP and falls among participants in all age groups. Conclusions: Among adults aged >= 55 taking antihypertensive medication, SBP between 120 and 139 mm Hg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

引用

页码：219 / 226

页数：8

共 29 条

[1]

[Anonymous], 1989, STROKE, V20, P1407

[2]

[Anonymous], ARCH MED SCI

[3]

[Anonymous], 2010, MINNESOTA CODE MANUA, DOI DOI 10.1007/978-1-84882-778-3

[4]

[Anonymous], J HYPERTENS

[5]

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents [J].

Aronow, Wilbert S. ;

Fleg, Jerome L. ;

Pepine, Carl J. ;

Artinian, Nancy T. ;

Bakris, George ;

Brown, Alan S. ;

Ferdinand, Keith C. ;

Forciea, Mary Ann ;

Frishman, William H. ;

Jaigobin, Cheryl ;

Kostis, John B. ;

Mancia, Giuseppi ;

Oparil, Suzanne ;

Ortiz, Eduardo ;

Reisin, Efrain ;

Rich, Michael W. ;

Schocken, Douglas D. ;

Weber, Michael A. ;

Wesley, Deborah J. ;

Harrington, Robert A. ;

Bates, Eric R. ;

Bhatt, Deepak L. ;

Bridges, Charles R. ;

Eisenberg, Mark J. ;

Ferrari, Victor A. ;

Fisher, John D. ;

Gardner, Timothy J. ;

Gentile, Federico ;

Gilson, Michael F. ;

Hlatky, Mark A. ;

Jacobs, Alice K. ;

Kaul, Sanjay ;

Moliterno, David J. ;

Mukherjee, Debabrata ;

Rosenson, Robert S. ;

Stein, James H. ;

Weitz, Howard H. ;

Wesley, Deborah J. .

CIRCULATION, 2011, 123 (21) :2434-2506

[6]

Hypertension therapy in the older adults-do we know the answers to all the questions? The status after publication of the ACCF/AHA 2011 expert consensus document on hypertension in the elderly [J].

Banach, M. ;

Aronow, W. S. .

JOURNAL OF HUMAN HYPERTENSION, 2012, 26 (11) :641-643

[7]

What should be the optimal levels of blood pressure: does the J-curve phenomenon really exist? [J].

Banach, Maciej ;

Michalska, Marta ;

Kjeldsen, Sverre E. ;

Malyszko, Jolanta ;

Mikhailidis, Dimitri P. ;

Rysz, Jacek .

EXPERT OPINION ON PHARMACOTHERAPY, 2011, 12 (12) :1835-1844

[8]

Barylski M, 2011, ARCH MED SCI, V7, P1055, DOI [10.5114/aoms.2011.26620, 10.5114/AOMS.2011.26620]

[9]

Treatment of hypertension in patients 80 years of age or older [J].

Beckett, Nigel S. ;

Peters, Ruth ;

Fletcher, Astrid E. ;

Staessen, Jan A. ;

Liu, Lisheng ;

Dumitrascu, Dan ;

Stoyanovsky, Vassil ;

Antikainen, Riitta L. ;

Nikitin, Yuri ;

Anderson, Craig ;

Belhani, Alli ;

Forette, Francoise ;

Rajkumar, Chakravarthi ;

Thijs, Lutgarde ;

Banya, Winston ;

Bulpitt, Christopher J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (18) :1887-1898

[10]

Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial [J].

Benavente, O. R. ;

Coffey, C. S. ;

Conwit, R. ;

Hart, R. G. ;

McClure, L. A. ;

Pearce, L. A. ;

Pergola, P. E. ;

Szychowski, J. M. ;

Benavente, O. R. ;

Hart, R. G. ;

Pergola, P. E. ;

Palacio, S. ;

Castro, I. ;

Farias, A. ;

Roldan, A. ;

Kase, C. ;

Gavras, I. ;

Lau, H. ;

Ogrodnik, M. ;

Allen, N. ;

Meissner, I. ;

Graves, J. ;

Herzig, D. ;

Covalt, J. ;

Meyer, B. ;

Jackson, C. ;

Gamble, P. ;

Kelly, N. ;

Warner, J. ;

Bell, J. ;

Demaerschalk, B. ;

Hogan, M. ;

Wochos, D. ;

Wieser, J. ;

Cleary, B. ;

Wood, L. ;

Hanna, J. ;

Zipp, T. ;

Bailey, S. ;

Cook, D. ;

Liskay, A. ;

Simcox, D. ;

Kappler, J. ;

Anderson, D. ;

Grimm, R. ;

Brauer, D. ;

Pettigrew, C. ;

Vaishnov, A. ;

Sawaya, P. ;

Fowler, A. .

LANCET, 2013, 382 (9891) :507-515

← 1 2 3 →