Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication

MacIej Banach, Samantha Bromfield, George Howard, Virginia J. Howard, Alberto Zanchetti, Wilbert S. Aronow, Ali Ahmed, Monika M. Safford, Paul Muntner

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication. Methods US adults ≥ 45 years of age taking antihypertensive medication enrolled in the REGARDS study were categorized into 3 age groups: 55-64, 65-74 and ≥ 75 years old and baseline on-treatment SBP levels. Our primary analyses focused on incident cardiovascular disease (CVD) (n = 9787) and all-cause mortality (n = 13,948). Results During follow-up, 530 (5.4%) participants had CVD events and 2095 (15%) participants died. After multivariable adjustment among participants ≥ 75, the incidence of CVD per 1000 person-years (95% confidence interval) was 16.9 (11.1-25.7), 13.4 (9.2-19.7), 11.6 (7.6-17.7), 17.8 (11.2-27.5) and 36.7 (26.6-50.8) at SBP levels of <120, 120-129, 130-139, 140-149, and ≥ 150 mm Hg, respectively. For the same SBP categories, the adjusted CVD incidence rates were 9.3 (7.2-12.0), 10.0 (8.1-12.3), 9.4 (7.5-11.8), 14.0 (11.0-17.8), and 16.4 (12.5-21.4), respectively, among participants 55-64 years, and 16.5 (13.6-21.5), 17.4 (14.8-20.6), 19.2 (16.4-22.5), 22.3 (18.6-26.9), and 27.6 (22.7-33.4), respectively, for participants 65-74 years. Among participants aged 55-64 and 65-74 years, a linear association was present between higher SBP categories and all-cause mortality risk (each p-trend <0.001). In contrast, for participants ≥ 75 years no association was present between SBP and all-cause mortality (p-trend = 0.319). No association was observed between SBP and falls among participants in all age groups. Conclusions Among adults aged ≥ 55 taking antihypertensive medication, SBP between 120 and 139 mm Hg was significantly associated with a reduced risk for cardiovascular and all-cause mortality outcomes.

Original languageEnglish
Pages (from-to)219-226
Number of pages8
JournalInternational Journal of Cardiology
Volume176
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Blood pressure
  • Coronary heart disease
  • Elderly
  • Hypertension
  • Mortality
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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