Delgado João, Masoli Jane A H, Bowman Kirsty, Strain W David, Kuchel George A, Walters Kate, Lafortune Louise, Brayne Carol, Melzer David, Ble Alessandro
Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
Healthcare for Older People, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, United Kingdom.
J Am Geriatr Soc. 2017 May;65(5):995-1003. doi: 10.1111/jgs.14712. Epub 2016 Dec 30.
To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice.
Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension.
Primary care practices in England (Clinical Practice Research Datalink).
Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline.
Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10-mmHg increments from less than 125 to 185 mmHg or more (reference 145-154 mmHg).
Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19-1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short- and long-term follow-up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group.
In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care.
根据常规家庭医疗中接受高血压治疗的最年长者所达到的血压水平来评估预后。
对高血压患者的初级保健住院和死亡证明数据进行队列分析。
英国的初级保健机构（临床实践研究数据链）。
年龄在80岁及以上、服用抗高血压药物且基线时无痴呆、癌症、冠心病、中风、心力衰竭和终末期肾衰竭的个体。
结局为死亡率、心血管事件和脆性骨折。收缩压（SBP）按10 mmHg的增量分组，范围从低于125 mmHg到185 mmHg及以上（参照组为145 - 154 mmHg）。
心肌梗死风险随收缩压升高呈线性增加，收缩压在145 mmHg及以上时中风风险增加，尽管收缩压在135至154 mmHg的个体死亡率最低。收缩压低于135 mmHg的患者中有13.1%的死亡率高于参照组（Cox风险比 = 1.25，95%置信区间 = 1.19 - 1.31；相当于每12.6名参与者多1例死亡）。这种死亡率差异在短期和长期随访中均一致；调整舒张压后风险未改变。收缩压低于125 mmHg的患者发生心力衰竭的发生率高于参照组。
在常规初级保健中，收缩压低于135 mmHg与无特定潜在混杂合并症的老年高血压患者更高的死亡率相关。尽管考虑了重要混杂因素，但观察性研究不能排除残余混杂。需要更多研究来确定高血压老年患者意外出现的收缩压低于135 mmHg是否可能是预后不良的有用临床指标，或许需要对整体护理进行临床评估。
