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Mortality, cognition poor in elderly patients with lower systolic BP

13 Jun 2018

Lower systolic blood pressure (BP) in very elderly patients receiving BP-lowering medications is associated with higher mortality and faster decline in cognitive function, according to a study.

The study included 570 participants from the population-based Leiden 85-plus cohort study. Researchers examined baseline systolic BP levels and use of antihypertensive treatment in relation to all-cause mortality and change in cognitive function as measured by the Mini-Mental State Examination. Grip strength was also assessed as a proxy for physical frailty.

Of the participants, 249 (44 percent) were prescribed antihypertensive treatment and 321 were not. Cardiovascular, socio-demographic and functional characteristics at baseline were equally distributed between the two participant groups, with the exception of cardiovascular disease, which was prevalent in those prescribed antihypertensives (61.9 percent vs 35.8 percent; p<0.001).

In the antihypertensive therapy group, all-cause mortality significantly increased with decreasing systolic BP (hazard ratio [HR], 1.29 per 10 mmHg lower systolic blood pressure; 95 percent CI, 1.15–1.46; p<0.001).

Likewise, decreasing systolic BP was associated with greater cognitive decline (annual mean change, −0.35 points per 10-mm Hg lower systolic BP; −0.60 to −0.11; p=0.004) among participants on BP-lowering medications. Of note, cognitive decline occurred more rapidly in those with lower hand grip strength.

No significant associations were seen between systolic BP and either mortality or cognitive decline among participants not prescribed antihypertensive treatment.

The present data bring to the forefront the question of what the optimal target BP level is for 85-year-old frail patients, researchers said. More studies are needed and should include patients that could benefit the most from deprescribing, such as those with frailty and/or limited life expectancy.

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