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Saturday, June 24, 2006

Very elderly may not benefit from low BP

Very elderly may not benefit from low BP:
Very elderly may not benefit from low BP
Low systolic blood pressure (BP) increases the risk of death among the very elderly, an epidemiological study suggests.

Research into the links between BP, death, and cardiovascular disease in old people have provided conflicting information, say the Finnish researchers.

In an attempt to clarify the matter, they conducted a population-based prospective study among 521 people (79% women) aged 85 years and above living in Vantaa, an industrial city in Southern Finland.

Mean systolic BP in the group was 149 mmHg and mean diastolic pressure was 82 mmHg. Just over half of patients (n=263) were taking BP-lowering medications, of whom 40.3% were taking a diuretic, 10.6% a calcium channel blocker, 9.4% a beta blocker, and 2.5% an ACE inhibitor.

Women were more likely to have previously diagnosed hypertension than men (27.7% vs 18.2%) and also more likely to use antihypertensive drugs (52.6% vs 42.7%).

During follow-up of up to 9 years (mean=3.5 years), 479 participants - 86.6% of the group - died. Multivariate analysis showed that death was linked to smoking (hazard ratio [HR]=1.97), functional status (HR=0.56), cancer (HR=1.42), dementia (HR=1.47), stroke (HR=1.80), and systolic BP of less than 140 mmHg (HR=1.35).

Interestingly, there was a tendency towards lower mortality among individuals with a systolic BP of 160 mmHg or greater. Other factors such as diastolic BP, a history of hypertension, and use of BP-lowering medication were not related to mortality, however.

Sari Rastas (Lohja Hospital) and colleagues report that the effect of lower systolic BP on mortality was particularly evident in patients without cancer, dementia, or a history of stroke.

Writing in the Journal of the American Geriatric Society, they conclude: "It is possible that the very old represent a select group of individuals, and the results from clinical trials including younger participants should be applied cautiously and individually in the very old."

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