P5728Association of systolic blood pressure and cardiovascular outcomes at different age groups in the healthy general population: a nationwide prospective cohort study

Abstract Background Uncertainties remain regarding the effect of blood pressure on various cardiovascular outcomes in different age groups. Purpose We aimed to identify 1) whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality and 2) whether SBP shows a linear association with cause-specific CVD mortality in all age groups among individuals without known hypertension and CVD. Methods We used the Korean National Health Insurance sample data (n=429,220). Participants were categorized into three groups by age (40–59, 60–69, and 70–80 years). Results A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80, the hazard ratios (HRs) (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34), and 1.34 (1.14–1.58) for SBP values of 120–129, 130–139, and 140–149 mm Hg, respectively, compared to SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72), and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19), and 1.29 (0.93–1.78). Nonlinear associations were significant for IHD (Fig 1). Figure 1 Conclusion In the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared to normal BP, and a linear association was not observed for IHD mortality in the range <140 mm Hg. Regarding an appropriate diagnostic cutoff for hypertension, an individualized approach considering each person's organ susceptibility is needed for the elderly population. Acknowledgement/Funding None

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Age-specific associations between systolic blood pressure and cardiovascular mortality

Heart ◽

10.1136/heartjnl-2019-314697 ◽

2019 ◽

Vol 105 (14) ◽

pp. 1070-1077 ◽

Cited By ~ 5

Author(s):

Mi-Hyang Jung ◽

Sang-Wook Yi ◽

Sang Joon An ◽

Jee-Jeon Yi

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Age Groups ◽

The Elderly ◽

Stroke Mortality ◽

Linear Association ◽

Sample Data ◽

Korean National Health Insurance ◽

Cvd Mortality

ObjectiveWe aimed to identify the following in all age groups among individuals without known hypertension and CVD: (1) Whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality. (2) Whether SBP shows a linear association with cause-specific CVD mortality.MethodsWe used the Korean National Health Insurance sample data (n=429 220). Participants were categorised into three groups by age (40–59 years, 60–69 years and 70–80 years).ResultsDuring 10.4 years of follow-up, 4319 cardiovascular deaths occurred. A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischaemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80 years, the HRs (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34) and 1.34 (1.14–1.58) for SBP values of 120–129 mm Hg, 130–139 mm Hg and 140–149 mm Hg, respectively, compared with SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72) and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19) and 1.29 (0.93–1.78), respectively. Non-linear associations were significant for IHD.ConclusionsIn the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared with normal blood pressure, and a linear association was not observed for IHD mortality in the range <140 mm Hg.

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Defining Hypotension in Moderate to Severely Injured Trauma Patients: Raising the Bar for the Elderly

The American Surgeon ◽

10.1177/000313481007601001 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1035-1038 ◽

Cited By ~ 8

Author(s):

Meghan Edwards ◽

Eric Ley ◽

James Mirocha ◽

Anoushiravan Amini Hadjibashi ◽

Daniel R. Margulies ◽

...

Keyword(s):

Blood Pressure ◽

Los Angeles ◽

Systolic Blood Pressure ◽

Hemorrhagic Shock ◽

Head Injuries ◽

Age Groups ◽

The Elderly ◽

Trauma Patients ◽

Severely Injured ◽

Definition Of

Hypotension, defined as systolic blood pressure less than 90 mm Hg, is recognized as a sign of hemorrhagic shock and is a validated prognostic indicator. The definition of hypotension, particularly in the elderly population, deserves attention. We hypothesized that the systolic blood pressure associated with increased mortality resulting from hemorrhagic shock increases with increasing age. The Los Angeles County Trauma Database was queried for all moderate to severely injured patients without major head injuries admitted between 1998 and 2005. Several fit statistic analyses were performed for each systolic blood pressure from 50 to 180 mm Hg to identify the model that most accurately defined hypotension for three age groups. The optimal definition of hypotension for each group was determined from the best fit model. A total of 24,438 patients were analyzed. The optimal definition of hypotension was systolic blood pressure of 100 mm Hg for patients 20 to 49 years, 120 mm Hg for patients 50 to 69 years, and 140 mm Hg for patients 70 years and older. The optimal systolic blood pressure for improved mortality in hemorrhagic shock increases significantly with increasing age. Elderly trauma patients without major head injuries should be considered hypotensive for systolic blood pressure less than 140 mm Hg.

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Trends in systolic blood pressure, 24-hour sodium excretion, and stroke mortality in the elderly in Belgium

The American Journal of Medicine ◽

10.1016/0002-9343(91)90428-z ◽

1991 ◽

Vol 90 (3) ◽

pp. S5-S11 ◽

Cited By ~ 17

Author(s):

Jozef V. Joossens ◽

Hugo Kesteloot

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Sodium Excretion ◽

The Elderly ◽

Stroke Mortality

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Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan

Scientific Reports ◽

10.1038/s41598-021-98072-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jinhong Cao ◽

Ehab S. Eshak ◽

Keyang Liu ◽

Ahmed Arafa ◽

Haytham A. Sheerah ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Cohort Analysis ◽

Temporal Trends ◽

Age Groups ◽

Stroke Mortality ◽

High Systolic Blood Pressure ◽

Men And Women ◽

China And Japan ◽

Disease Study

AbstractStroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality.

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Strategy for the Prevention of Cardiovascular Diseases in East Asian Countries Based on the Experience of Japan

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:10 ◽

2011 ◽

Vol 3 (1) ◽

pp. 10

Author(s):

Hirotsugu Ueshima ◽

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Mortality Rate ◽

Salt Intake ◽

East Asian ◽

Age Groups ◽

Blood Pressure Level ◽

The Elderly ◽

Stroke Mortality ◽

Asian Countries

Cardiovascular disease is a major cause of morbidity and mortality in East Asian countries as well as in western countries. However, it is a characteristic specific to East Asia that stroke is more prevalent than coronary heart disease (CHD). In 1965, Japan had the highest stroke mortality rate in the world, but the rate has since declined substantially: the age-adjusted stroke mortality rate fell by around 80% from 1965 to 1990. Risk factors for stroke in Asian countries include hypertension, smoking and diabetes. Hypercholesterolaemia is not a strong risk factor for stroke or even for ischemic stroke, but it is a risk factor for CHD in Asian countries as well as in western counties. Therefore, the control of blood pressure and diabetes and cessation of smoking are crucial for preventing stroke and disability in the elderly. During the last four decades in Japan, the blood pressure level has fallen among both sexes and in all age groups: the systolic blood pressure (SBP) of men 60–69 years of age fell by 16mmHg from 1965 to 1990. This is estimated to have reduced stroke mortality by around 50% because, based on Japanese cohort studies, an SBP reduction of 1mmHg may lead to a 3% reduction in the incidence of stroke. Similarly, a 1% reduction in the incidence of smoking may lead to a 1.3% reduction in the incidence of stroke, so the 20% reduction of the smoking rate during this period is estimated to have led to a 26% reduction in the incidence of stroke. In addition, the significant reduction in salt consumption over this time period, by at least 10–15g per day, has substantially reduced blood pressure among the Japanese population. Lowering blood pressure by reducing salt intake, promoting smoking cessation and preventing diabetes are therefore key strategies for preventing stroke and disability in the elderly.

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Observer Error in Systolic Blood Pressure Measurement in the Elderly

Archives of Internal Medicine ◽

10.1001/archinte.1986.00360240099017 ◽

1986 ◽

Vol 146 (12) ◽

pp. 2373 ◽

Cited By ~ 16

Author(s):

Khin Mae Hla

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

The Elderly ◽

Systolic Blood Pressure Measurement ◽

Observer Error

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HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

10.36106/ijsr/5704603 ◽

2021 ◽

pp. 56-57

Author(s):

Rohit Arora ◽

D.K Sharma

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

The Elderly ◽

Common Disease ◽

Old Patients ◽

Current Trends ◽

Increased Risk ◽

Individualized Approach ◽

Risk Of Falls ◽

Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

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Ambulatory Blood Pressure Recordings in Children and Adolescents

PEDIATRICS ◽

10.1542/peds.94.2.180 ◽

1994 ◽

Vol 94 (2) ◽

pp. 180-184

Author(s):

Gregory A. Harshfield ◽

Bruce S. Alpert ◽

Derrick A. Pulliam ◽

Grant W. Somes ◽

Dawn K. Wilson

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Ambulatory Blood Pressure ◽

Reference Data ◽

Blood Pressure Monitoring ◽

Age Groups ◽

Specific Reference ◽

Pressure Monitoring ◽

Black And White

Objective. To provide reference data for ambulatory blood pressure monitoring (ABPM) and to determine the influence of age, sex, and race on these values. Methods. ABPM was performed on 300 healthy, normotensive boys and girls between the ages of 10 and 18 years, including 160 boys and 140 girls, of whom 149 were white and 151 were black. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) while awake and during sleep were calculated for black and white boys and girls aged 10 to 12 years, 13 to 15 years, and 16 to 18 years. Results. Boys compared with girls 10 to 12 years of age had higher mean (±SD) SBP (115 ± 9 vs 112 ± 9 mm Hg; P < .01) and DBP (67 ± 7 vs 65 ± 5 mm Hg; P < .01) while awake. Boys compared to girls 13 to 15 years of age had higher SBP while awake (116 ± 11 vs 112 ± 8 mm Hg; P < .01). Boys compared with girls 16 to 18 years of age had higher SBP while awake (125 ± 12 vs 111 ± 9 mm Hg; P < .01) and during sleep (116 ± 11 vs 106 ± 9 mm Hg). Comparisons within sex showed similar changes with age for boys and girls. Blacks compared with whites 13 to 15 years of age had higher SBP during sleep (109 ± 11 vs 105 ± 10 mm Hg; P < .01), and blacks compared with whites 16 to 18 years of age had higher DBP during sleep (66 ± 7 vs 58 ± 6 mm Hg; P < .01). Comparisons across age groups within race showed that blacks 16 to 18 years of age had higher SBP during sleep than blacks 10 to 12 years of age (109 ± 11 vs 104 ± 10 mm Hg), and higher DBP during sleep (66 ± 7 mm Hg; P < .01) than blacks 10 to 12 years of age (61 ± 7 mm Hg; P < .01) and 13 to 15 years of age (61 ± 8; P < .01 mm Hg). The changes with age were not significant for white subjects. Conclusion. These results provide age-specific reference data for ABPM in youths. These values differ by sex (boys more than girls) and race (Blacks more than Whites).

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