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Disentangling the varying associations between systolic blood pressure and health outcomes in the very old: an individual patient data meta-analysis

Lookup NU author(s): Emerita Professor Carol Jagger, Dr Andrew KingstonORCiD, Professor Dame Louise Robinson

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. OBJECTIVES: While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardiovascular diseases (CVD), and cognitive and physical fitness on the associations between SBP and health outcomes in the very old. METHODS: Five cohorts from the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included in a two-step individual participant data meta-analysis (IPDMA). We pooled hazard ratios (HR) from Cox proportional-hazards models for 5-year mortality and estimates of linear mixed models for change in cognitive and functional decline. Models were stratified by BP-lowering treatment, history of CVD, Mini-Mental State Examination scores, grip strength (GS) and body mass index (BMI). RESULTS: Of all 2480 participants (59.9% females, median 85 years), median baseline SBP was 149 mmHg, 64.3% used BP-lowering drugs and 47.3% had a history of CVD. Overall, higher SBP was associated with lower all-cause mortality (pooled HR 0.91 [95% confidence interval 0.88-0.95] per 10 mmHg). Associations remained irrespective of BP-lowering treatment, history of CVD and BMI, but were absent in octogenarians with above-median MMSE and GS. In pooled cohorts, SBP was not associated with cognitive and functional decline. CONCLUSION: While in the very old with low cognitive or physical fitness a higher SBP was associated with a lower all-cause mortality, this association was not evident in fit octogenarians. SBP was not consistently associated with cognitive and functional decline.


Publication metadata

Author(s): Bogaerts JMK, Poortvliet RKE, van der Klei VMGTH, Achterberg WP, Blom JW, Teh R, Muru-Lanning M, Kerse N, Rolleston A, Jagger C, Kingston A, Robinson L, Arai Y, Shikimoto R, Gussekloo J

Publication type: Article

Publication status: Published

Journal: Journal of Hypertension

Year: 2022

Volume: 40

Issue: 9

Pages: 1786-1794

Print publication date: 01/09/2022

Online publication date: 11/07/2022

Acceptance date: 14/05/2022

Date deposited: 01/09/2022

ISSN (print): 0263-6352

ISSN (electronic): 1473-5598

Publisher: Lippincott Williams & Wilkins

URL: https://doi.org/10.1097/HJH.0000000000003219

DOI: 10.1097/HJH.0000000000003219

PubMed id: 35822583


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Funding

Funder referenceFunder name
21590775
345426/00
15KT0091
BBSRC
Dutch Ministry of Health, Welfare and Sports
British Heart Foundation
Dunhill Medical Trust
HRC 09/068B
Keio Global Research Institute
MRC
National Institute for Health Research School for Primary Care
New Zealand National Centre for Research Excellence for Maori
NHS North of Tyne (Newcastle Primary Care Trust)
Newcastle University
Unilever Corporate Research

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