According to some observational studies, low blood pressure (BP) independently predicts mortality in very old people (JW Jun 27 2006). In this population-based cohort study from a Swedish county, researchers collected detailed information on 348 very old people (age,
85) and followed them for 4 years; 57% died during that period.Mean baseline BP was 148/76 mm Hg. In a multivariate analysis that was adjusted for numerous clinical, psychosocial, and medication-use variables, systolic BP
120 mm Hg was associated with significantly greater mortality than was systolic BP between 120 mm Hg and 160 mm Hg. Exclusion of deaths during the first year of follow-up (to eliminate cases in which low BP was a pre-terminal development) did not change these findings.Comment: This study joins several others in suggesting an inverse relation between blood pressure and mortality in the oldest segment of the population. The study’s strengths include prospective collection of detailed data, although residual confounding is always a possibility. The implication is that BP should not be lowered aggressively in very old people with mild hypertension. Note that these results do not necessarily contradict those of the recently published HYVET study in which treatment of hypertension in very old patients (age,
80) was beneficial (JW Apr 17 2008). Compared with patients in the current study, HYVET patients had higher baseline BP (mean, 173/91 mm Hg) but were younger (mostly 80–84) and had fewer comorbidities.— Allan S. Brett, MD
Published in Journal Watch General Medicine October 30, 2008