Li Menghuan, Su Zhenyang, Su Hu, Zuo Zhi, He Yuan, Yao Wenming, Yang Jiaming, Zhang Kerui, Wang Hui, Kong Xiangqing
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
School of Medicine, Southeast University, Nanjing, China.
Front Cardiovasc Med. 2022 Aug 1;9:919956. doi: 10.3389/fcvm.2022.919956. eCollection 2022.
The optimal blood pressure of elderly people with frailty or prefrailty is still unclear. We aimed to explore the relationship between blood pressure and mortality in the elderly with (pre)frailty.
A total of 528 participants aged 60 years and older were exacted for analyses of the association between blood pressure and mortality from the database of the National Health and Nutrition Examination Survey (NHANES) (1999-2004). Kaplan-Meier curves and log-rank tests were used to investigate the differences in survival between groups. Multivariable Cox regression and restricted cubic spline (RCS) analyses were applied to explore the relationship between blood pressure and mortality.
During the median follow-up time of 116.5 [interquartile range (IQR) of 60-186] months, 363 all-cause deaths and 122 cardiac deaths were documented. For all-cause mortality, more participants died with systolic blood pressure (SBP) < 110 mmHg and SBP ≥ 170 mmHg (log-rank = 0.004). After adjusting for confounders, SBP < 110 mmHg [hazard ratio () 1.52, 95% : 0.96-2.41] and SBP ≥ 170 mmHg ( 1.53, 95% : 1.09-2.15) had higher risks of all-cause mortality compared with SBP within 130-150 mmHg. There were no significant differences in all-cause mortality among DBP categories. A J-curve association was identified between the SBP and hazard ratio for all-cause mortality ( for non-linear = 0.028), with 138.6 mmHg as the lowest hazard ratio of all-cause mortality; each 10 mmHg of SBP rise was associated with a 9% increased risk in all-cause mortality ( 1.09, 95% 1.00-1.18). Additionally, a non-linear relationship was determined between SBP and the hazard ratio for cardiac deaths ( for non-linear = 0.030), with 140.1 mmHg as the lowest hazard ratio of cardiac deaths. When SBP was higher than 140.1 mmHg, each 10 mmHg rise in SBP was associated with a 17% increased risk of cardiac deaths ( 1.17, 95% : 1.02-1.34).
Both lower and higher SBP levels are associated with higher risks of all-cause mortality in older individuals with (pre)frailty. There are J-shaped associations between SBP and mortality, with the optimal SBP being approximately 140 mmHg for this population specifically.
虚弱或衰弱前期老年人的最佳血压仍不明确。我们旨在探讨（衰弱前期）衰弱老年人血压与死亡率之间的关系。
从国家健康与营养检查调查（NHANES）（1999 - 2004年）数据库中选取528名60岁及以上参与者，分析血压与死亡率之间的关联。采用Kaplan - Meier曲线和对数秩检验来研究组间生存率差异。应用多变量Cox回归和受限立方样条（RCS）分析来探讨血压与死亡率之间的关系。
在中位随访时间116.5[四分位间距（IQR）为60 - 186]个月期间，记录了363例全因死亡和122例心脏死亡。对于全因死亡率，收缩压（SBP）<110 mmHg和SBP≥170 mmHg的参与者死亡人数更多（对数秩 = 0.004）。在调整混杂因素后，与SBP在130 - 150 mmHg范围内相比，SBP<110 mmHg[风险比（HR）1.52，95%置信区间（CI）：0.96 - 2.41]和SBP≥170 mmHg（HR 1.53，95% CI：1.09 - 2.15）的全因死亡风险更高。舒张压类别之间的全因死亡率无显著差异。SBP与全因死亡率的风险比之间存在J形关联（非线性检验P = 0.028），全因死亡率的最低风险比对应的SBP为138.6 mmHg；SBP每升高10 mmHg，全因死亡风险增加9%（HR 1.09，95% CI：1.00 - 1.18）。此外，SBP与心脏死亡的风险比之间存在非线性关系（非线性检验P = 0.030），心脏死亡的最低风险比对应的SBP为140.1 mmHg。当SBP高于140.1 mmHg时，SBP每升高10 mmHg，心脏死亡风险增加17%（HR 1.17，95% CI：1.02 - 1.34）。
在（衰弱前期）衰弱的老年人中，较低和较高的SBP水平均与全因死亡风险较高相关。SBP与死亡率之间存在J形关联，该人群的最佳SBP约为140 mmHg。
