Institute for Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
J Am Med Dir Assoc. 2012 Oct;13(8):759.e1-6. doi: 10.1016/j.jamda.2012.05.005. Epub 2012 Jun 13.
Hypertension is among the most common chronic complaints of older people. Among very old people with common co morbidities, it remains uncertain whether the benefits of long-term treatment seen among younger people, are also observed. Our objective was to assess the relationship of blood pressure (BP) at age 85 with 5-year all-cause mortality.
A longitudinal prospective cohort study, of an age-homogenous, representative sample born 1920-1921.
Community-based home assessments.
West Jerusalem residents (1159) born 1920-1921, all aged age 85 during 2005-2006, currently enrolled in the Jerusalem Longitudinal Study.
None.
Comprehensive geriatric assessment of numerous health variables. BP was determined as the average of 6 measurements, from 2 separate home visits. Hypertension (HTN) defined as either treatment with antihypertensive medications, or blood pressure >140 mm Hg systolic, or >90 mm Hg. The study outcome was all-cause 5-year mortality. Mortality data were collected from the National Ministry of Interior.
One hundred and nine (9.4%) were normotensive, 152 (13.1%) untreated, and 898 (77.5%) treated hypertensives. Treatment rate was 78%, and controlled hypertension rate 38%. During 5 years 328 (28.3%) patients died. Kaplan-Meier survival curves and log rank analysis showed no difference in mortality between normotensive, untreated and treated hypertensive subjects according to sex. Treated subjects with controlled Systolic Blood Pressure (SBP) had lowest survival rate of 67%, P = .029. Continuous SBP yielded a hazard ratio (HR) for mortality of 1.00, (95% CI 0.95-1.01), after adjusting in Cox proportional hazard models for sex, heart failure, physical activity, self-rated health, diabetes, coronary and cerebrovascular diseases, smoking and antihypertensive therapy. Results were unaffected after excluding 114 deaths within the first 2-years of follow-up. Similar results were found when examining BP either as a dichotomous variable, according to treatment, or pulse pressure.
Raised SBP was not associated with increased 5-year mortality among a representative cohort of community-dwelling 85-year-olds. Indeed, before adjustment for co morbidities, subjects with controlled SBP tended to have a worse survival.
高血压是老年人最常见的慢性疾病之一。在患有常见合并症的非常老年人中，尚不确定年轻人中观察到的长期治疗益处是否也存在。我们的目的是评估 85 岁时的血压（BP）与 5 年全因死亡率之间的关系。
一项针对年龄同质、代表性样本的纵向前瞻性队列研究，这些样本出生于 1920-1921 年。
社区为基础的家庭评估。
1920-1921 年出生的耶路撒冷西部居民（1159 人），在 2005-2006 年期间均年满 85 岁，目前参加了耶路撒冷纵向研究。
无。
多项健康变量的全面老年评估。BP 是从 2 次家庭访问中的 6 次测量结果的平均值确定的。高血压（HTN）定义为使用抗高血压药物治疗，或收缩压>140mmHg，或舒张压>90mmHg。研究结果是全因 5 年死亡率。死亡率数据来自内政部。
109 人（9.4%）血压正常，152 人（13.1%）未接受治疗，898 人（77.5%）接受治疗的高血压患者。治疗率为 78%，控制高血压率为 38%。在 5 年内，328 名（28.3%）患者死亡。Kaplan-Meier 生存曲线和对数秩分析显示，根据性别，血压正常、未治疗和治疗的高血压患者之间的死亡率没有差异。接受治疗且收缩压（SBP）得到控制的患者的生存率最低，为 67%，P=0.029。在 Cox 比例风险模型中，连续 SBP 对死亡率的危害比（HR）为 1.00（95%CI 0.95-1.01），该模型调整了性别、心力衰竭、体力活动、自我报告的健康状况、糖尿病、冠心病和脑血管疾病、吸烟和抗高血压治疗。在排除随访前 2 年内的 114 例死亡后，结果仍然没有影响。当检查 BP 作为一个二分类变量，根据治疗，或脉压时，也得到了相似的结果。
在一个具有代表性的社区 85 岁人群队列中，升高的 SBP 与 5 年死亡率的增加无关。事实上，在调整合并症之前，控制 SBP 的患者的生存状况往往更差。
