In the Journals

Moderately elevated systolic BP increases stroke odds in elderly adults

Older Korean adults with a systolic BP between 130 mm Hg and 139 mm Hg had a higher stroke mortality rate compared with older adults with a normal BP, according to findings published in Heart.

Mi-Hyang Jung, MD, and colleagues investigated whether a systolic BP between 130 mm Hg and 139 mm Hg elevates CVD mortality. The researchers also aimed to discern whether there is a linear association between systolic BP and cause-specific CVD mortality.

“Although serval large-scale epidemiological studies have addressed the age-specific relationships between BP and cardiovascular outcomes, most studies included hypertensive patients already taking medications and were largely based on data from Western populations,” Jung, an assistant professor of cardiology at the Cardiovascular Center at Chuncheon Sacred Heart Hospital in South Korea, and colleagues wrote. “To establish an effective preventive strategy in Asian populations, prospective observational studies reflecting Asian-specific characteristics are needed.”

Positive and graded association

Jung and colleagues analyzed data from of 429,220 patients in the Korean National Health Insurance Service database. Participants were stratified into three age groups ranging from 40 to 59 years to 70 to 80 years.

In a follow-up period of 10.4 years, 4,319 CVD deaths occurred, the researchers wrote.

A positive and graded association was generally observed between systolic BP and overall and cause-specific CVD mortality regardless of age, apart from ischemic heart disease in adults aged 70 to 80 years, Jung and colleagues wrote.

Older Korean adults with a systolic BP between 130 mm Hg and 139 mm Hg had a higher stroke mortality rate compared with older adults with a normal BP, according to findings published in Heart.
Source: Adobe Stock

Adults aged 70 to 80 years with systolic BP between 120 mm Hg and 129 mm Hg had a HR for CVD mortality of 1.08 (95% CI, 0.92-1.28) compared with patients with a systolic BP lower than 120 mm Hg, the researchers wrote. The HRs were more pronounced compared with the less than 120-mm-Hg group, older adults with systolic BP 130 mm Hg to 139 mm Hg (HR = 1.14; 95% CI, 0.97-1.34) and systolic BP 140 mm Hg to 149 mm Hg (HR = 1.34; 95% CI, 1.14-1.58).

There was a nonlinear relationship between systolic BP level and ischemic heart disease mortality rate in elderly adults, according to the researchers.

Compared with less than 120-mm-Hg group, those with higher systolic BP had elevated risk for stroke mortality (HR for 120-129 mm Hg = 1.29; 95% CI, 1.02-1.64; HR for 130-139 mm Hg = 1.37; 95% CI, 1.09-1.72; HR for 140-149 mm Hg = 1.52; 95% CI, 1.2-1.93), Jung and colleagues wrote.

“Given the rapidly growing aging population, subsequent interventional and/or epidemiological studies would be helpful to clarify whether the initiation of BP interventions at a lower threshold would lead to improvements in various cardiovascular outcomes across age and racial groups,” the researchers wrote.

Need for more reliable evidence

In a related editorial, Ana-Catarina Pinho-Gomes, MD, MSc, and Kazem Rahimi, FRCP, DM, MSc, FESC, of the George Institute for Global Health at the University of Oxford, U.K., wrote: “The population-based study by Jung et al provides reassurance about an overall positive association between BP and CVD risk in the elderly in a non-Western population. It further highlights the need for more reliable evidence from randomized trial to assess the balance of safety and efficacy of antihypertensive treatment in elderly patients, in particular when BP is not very high and in the presence of comorbidities. Until such evidence becomes available, ‘clinical judgement’ with its inherent limitations will remain the best standard that guidelines can recommend.” – by Earl Holland Jr.

Disclosures: The authors and editorial writers report no relevant financial disclosures.

Older Korean adults with a systolic BP between 130 mm Hg and 139 mm Hg had a higher stroke mortality rate compared with older adults with a normal BP, according to findings published in Heart.

Mi-Hyang Jung, MD, and colleagues investigated whether a systolic BP between 130 mm Hg and 139 mm Hg elevates CVD mortality. The researchers also aimed to discern whether there is a linear association between systolic BP and cause-specific CVD mortality.

“Although serval large-scale epidemiological studies have addressed the age-specific relationships between BP and cardiovascular outcomes, most studies included hypertensive patients already taking medications and were largely based on data from Western populations,” Jung, an assistant professor of cardiology at the Cardiovascular Center at Chuncheon Sacred Heart Hospital in South Korea, and colleagues wrote. “To establish an effective preventive strategy in Asian populations, prospective observational studies reflecting Asian-specific characteristics are needed.”

Positive and graded association

Jung and colleagues analyzed data from of 429,220 patients in the Korean National Health Insurance Service database. Participants were stratified into three age groups ranging from 40 to 59 years to 70 to 80 years.

In a follow-up period of 10.4 years, 4,319 CVD deaths occurred, the researchers wrote.

A positive and graded association was generally observed between systolic BP and overall and cause-specific CVD mortality regardless of age, apart from ischemic heart disease in adults aged 70 to 80 years, Jung and colleagues wrote.

Older Korean adults with a systolic BP between 130 mm Hg and 139 mm Hg had a higher stroke mortality rate compared with older adults with a normal BP, according to findings published in Heart.
Source: Adobe Stock

Adults aged 70 to 80 years with systolic BP between 120 mm Hg and 129 mm Hg had a HR for CVD mortality of 1.08 (95% CI, 0.92-1.28) compared with patients with a systolic BP lower than 120 mm Hg, the researchers wrote. The HRs were more pronounced compared with the less than 120-mm-Hg group, older adults with systolic BP 130 mm Hg to 139 mm Hg (HR = 1.14; 95% CI, 0.97-1.34) and systolic BP 140 mm Hg to 149 mm Hg (HR = 1.34; 95% CI, 1.14-1.58).

There was a nonlinear relationship between systolic BP level and ischemic heart disease mortality rate in elderly adults, according to the researchers.

Compared with less than 120-mm-Hg group, those with higher systolic BP had elevated risk for stroke mortality (HR for 120-129 mm Hg = 1.29; 95% CI, 1.02-1.64; HR for 130-139 mm Hg = 1.37; 95% CI, 1.09-1.72; HR for 140-149 mm Hg = 1.52; 95% CI, 1.2-1.93), Jung and colleagues wrote.

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“Given the rapidly growing aging population, subsequent interventional and/or epidemiological studies would be helpful to clarify whether the initiation of BP interventions at a lower threshold would lead to improvements in various cardiovascular outcomes across age and racial groups,” the researchers wrote.

Need for more reliable evidence

In a related editorial, Ana-Catarina Pinho-Gomes, MD, MSc, and Kazem Rahimi, FRCP, DM, MSc, FESC, of the George Institute for Global Health at the University of Oxford, U.K., wrote: “The population-based study by Jung et al provides reassurance about an overall positive association between BP and CVD risk in the elderly in a non-Western population. It further highlights the need for more reliable evidence from randomized trial to assess the balance of safety and efficacy of antihypertensive treatment in elderly patients, in particular when BP is not very high and in the presence of comorbidities. Until such evidence becomes available, ‘clinical judgement’ with its inherent limitations will remain the best standard that guidelines can recommend.” – by Earl Holland Jr.

Disclosures: The authors and editorial writers report no relevant financial disclosures.