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Blood pressure management in the elderly: the need for more randomised evidence
  1. Ana-Catarina Pinho-Gomes,
  2. Kazem Rahimi
  1. The George Institute for Global Health, University of Oxford, Oxford, UK
  1. Correspondence to Professor Kazem Rahimi, George Institute, University of Oxford, Oxford OX1 2JD, UK; kazem.rahimi{at}georgeinstitute.ox.ac.uk

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Our understanding of relationships between blood pressure (BP) and major vascular outcomes has greatly advanced. Yet there remain important uncertainties which affect guideline recommendations and treatment decisions. One major area of uncertainty and controversy is the treatment of BP in elderly patients, in particular when BP values are not very high.

In their Heart paper, Jung et al 1 aim to investigate this question further. Using the Korean National Health Insurance database, they identify a cohort of about 4 20 000 individuals with an average followed-up duration of 10 years to investigate adjusted associations for death due to cardiovascular disease (CVD). Overall, the study confirms the growing evidence on the graded association between BP and risk of CVD. The authors report a 40% increased risk of CVD death per 20 mm Hg higher baseline systolic BP, with no evidence of a change in pattern at any particular BP threshold. Also in keeping with previous literature, the strength of the association with BP is shown to vary by the specific type of CVD outcome, with a weaker association observed for ischaemic heart disease (IHD) than stroke, particularly haemorrhagic stroke. The study also adds to the existing literature by implicitly showing no evidence of a major difference in patterns of associations by ethnicity.

But, how does this study contribute to the question of BP management in elderly patients? The investigators divide the population into three age groups of 40–59, 60–69 and 70–80 years and repeat analysis for each group separately. Again, consistent with the previous literature, they observe a declining slope of association with increasing age. Even in the oldest patient group, there was a log-linear association between BP and risk of CVD death; for each …

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