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Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality?

Abstract：

OBJECTIVE:To determine the association between hypertension at age 90 years, treatment, and 5-year mortality. DESIGN:A prospective observational study of a representative community-dwelling birth cohort (born 1920-1921) by the Jerusalem Longitudinal Study (1990-2015). SETTING:Home-assessment. PARTICIPANTS:480 subjects aged 90, examined 2010-2011. Measurements and Main Outcome: Hypertension was defined as treatment with antihypertensive medication, and/or sitting blood pressure (BP) > 140 mmHg systolic or >90 mmHg diastolic. Subjects were categorized as normotensive (NORMO), untreated hypertensive (NonTx-HTN), and treated hypertensive (Tx-HTN); assessment included activities of daily living (ADL), handgrip strength, and all-cause mortality (2010-2015). RESULTS:NORMO, NonTx-HTN, and Tx-HTN prevalence was 12.3% (59/480), 12.7% (61/480), and 75% (360/480). Tx-HTN had higher rates of low education, depression, low physical activity, chronic heart failure, ischemic heart disease, chronic kidney disease. Five-year survival was lowest among Tx-HTN and highest among NonTx-HTN versus NORMO among all subjects (51%, 72%, 61%; P = .01), and subgroups with ADL independence (64%, 91%, 74%; n = 265, P = .01), ADL dependence (37%, 55%, 48%; n = 194, P = .36), high grip strength (66%, 85%, 83%; n = 227, P = .04), low grip strength (38%, 60%, 61%; n = 149, P = .06), low comorbidity (64%, 84%, 70%; n = 219, P = .13), and high comorbidity (42%, 60%, 54%; n = 257, P = .12). Unadjusted mortality hazards ratios (HR) were higher for Tx-HTN [HR 1.38; 95% confidence interval (CI) 0.89-2.15] versus NonTx-HTN (HR 0.7; 95% CI 0.37-1.31) compared to NORMO (HR 1.0). After adjusting for medical and functional covariates, adjusted HRs were higher for Tx-HTN (HR 1.39; 95% CI 0.83-2.33) versus NonTx-HTN (HR 0.67; 95% CI 0.31-1.45) compared to NORMO (HR 1.0). Findings were consistent in subsets according to ADL status, grip strength, and comorbidity. CONCLUSIONS:Untreated hypertension at age 90 years was not associated with increased mortality risk among community-dwelling elderly, irrespective of comorbidity, functional status, or muscle strength.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Stessman J,Bursztyn M,Gershinsky Y,Hammerman-Rozenberg A,Jacobs JM

doi

10.1016/j.jamda.2016.12.076

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

277.e13-277.e19

issue

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(16)30680-6

journal_volume

pub_type

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Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality?