Hakala S M, Tilvis R S, Strandberg T E
Department of Medicine, University of Helsinki, Finland.
Eur Heart J. 1997 Jun;18(6):1019-23. doi: 10.1093/oxfordjournals.eurheartj.a015360.
Hypertension is an established risk factor of cardiovascular diseases, and in clinical studies its treatment has reduced cardiovascular complications in subjects up to 80 years of age. In the older age groups, prognostic data on blood pressure is sparse. We evaluated the prognostic significance of different blood pressure levels and the history of elevated blood pressure in an older population.
In the Helsinki Ageing Study random individuals 75, 80, and 85 years of age (n = 521) were evaluated at baseline using postal questionnaires, structured interviews, clinical examinations, laboratory investigations, and blood pressure measurements (supine, seated, standing). Date of death during a 5-year follow-up was verified using computerized registers, and thus the follow-up was 100% complete. The data were analysed using life-table analyses and Cox proportional hazards models.
At 5 years, 240 subjects (40%) had died, 50% of them of cardiovascular disease. In crude analyses, an inverse relationship between both systolic and diastolic blood pressure and mortality was observed in all groups combined (P < 0.01), and separately in the 80 and 85-year-old groups. However, a J-shaped link between diastolic blood pressure and mortality was found in the 75-year-old group. After controlling for age, gender and the presence of clinically significant diseases (in 72% of subjects) baseline blood pressure was associated with favourable 5-year survival. The risk ratios of systolic (per 10 mmHg) and diastolic blood pressure (per 5 mmHg) were 0.90 (95% CI 0.85-0.96) and 0.92 (95% CI 0.86-0.99), respectively. Neither isolated systolic hypertension nor a history of hypertension treatment were associated with 5-year survival.
At the population level, among subjects aged 75 years and over, favourable 5-year survival is indicated by a high, but not a low, blood pressure.
高血压是心血管疾病已确定的危险因素，在临床研究中，其治疗已减少了80岁及以下受试者的心血管并发症。在老年人群体中，关于血压的预后数据稀少。我们评估了老年人群中不同血压水平及高血压病史的预后意义。
在赫尔辛基老龄化研究中，对75岁、80岁和85岁的随机个体（n = 521）在基线时使用邮政问卷、结构化访谈、临床检查、实验室检查和血压测量（仰卧位、坐位、站立位）进行评估。通过计算机化登记核实5年随访期间的死亡日期，因此随访完成率为100%。使用生命表分析和Cox比例风险模型对数据进行分析。
5年后，240名受试者（40%）死亡，其中50%死于心血管疾病。在粗略分析中，合并所有组观察到收缩压和舒张压与死亡率之间呈负相关（P < 0.01），在80岁和85岁组中分别观察到这种关系。然而，在75岁组中发现舒张压与死亡率之间呈J形关联。在控制年龄、性别和临床显著疾病的存在（72%的受试者）后，基线血压与良好的5年生存率相关。收缩压（每10 mmHg）和舒张压（每5 mmHg）的风险比分别为0.90（95%CI 0.85 - 0.96）和0.92（95%CI 0.86 - 0.99）。单纯收缩期高血压和高血压治疗史均与5年生存率无关。
在人群层面，75岁及以上的受试者中，较高而非较低的血压表明5年生存率良好。
