Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
School of Nursing, Kanazawa Medical University, Ishikawa, Japan.
Hypertens Res. 2014 Aug;37(8):772-8. doi: 10.1038/hr.2014.67. Epub 2014 Mar 27.
A reduction of elevated blood pressure (BP) is an important treatment goal in elderly hypertensive patients. However, excessive reduction of systolic BP (SBP) and/or diastolic BP (DBP) might be harmful in such patients. We investigated whether this was the case with regard to risk of incident disability or death in community-dwelling elderly subjects. We analyzed 570 patients receiving antihypertensive treatment aged 65-94 years. The endpoint was the composite outcome of incident disability, defined as first certification of a support/care need or death. Relationships among each of the four classes of SBP or DBP and the risk of incident disability or death were estimated using the Cox proportional hazards model. Over four years, 77 (13.5%) incident disabilities or deaths occurred. After adjustment for age, sex and variables selected according to their univariate analysis P-value <0.20, the risk of events was significantly higher in subjects with baseline SBP<120 mm Hg (hazard ratio (HR)=2.81, P=0.023) and ⩾160 mm Hg (HR=4.32, P<0.001), compared with subjects with baseline SBP of 140-159 mm Hg, who showed the lowest incidence of events. This J-curve relationship was observed in very elderly patients (⩾75 years) but not in younger patients. Patients with SBP<120 mm Hg tended to have a higher risk of incident disability caused by cerebral events, and those with SBP⩾160 mm Hg had a higher risk of incident disability caused by falls/bone fractures. These observations indicate that excessive BP reduction could cause discontinuance of disability-free survival in community-dwelling elderly patients.
降低血压（BP）是老年高血压患者的重要治疗目标。然而，在这些患者中，收缩压（SBP）和/或舒张压（DBP）的过度降低可能是有害的。我们研究了这是否与社区居住的老年患者发生残疾或死亡的风险有关。我们分析了 570 名接受降压治疗的年龄在 65-94 岁的患者。终点是残疾的复合结局，定义为首次认证需要支持/护理或死亡。使用 Cox 比例风险模型估计 SBP 或 DBP 的每四类与残疾或死亡事件发生风险之间的关系。在四年内，77 例（13.5%）发生残疾或死亡事件。在调整年龄、性别以及根据单变量分析 P 值<0.20 选择的变量后，基线 SBP<120mmHg 的患者发生事件的风险显著更高（风险比（HR）=2.81，P=0.023）和 ⩾160mmHg（HR=4.32，P<0.001），与基线 SBP 为 140-159mmHg 的患者相比，后者的事件发生率最低。这种 J 型曲线关系在非常老年患者（⩾75 岁）中观察到，但在年轻患者中未观察到。SBP<120mmHg 的患者发生由脑事件引起的残疾的风险较高，而 SBP ⩾160mmHg 的患者发生由跌倒/骨折引起的残疾的风险较高。这些观察结果表明，过度的 BP 降低可能导致社区居住的老年患者残疾无生存时间的中断。
