Blood pressure and mortality in very old people.
Blood pressure and mortality in very old people.
复制标题
老年人的血压和死亡率。
DOI：
10.1111/j.1532-5415.2009.02237.x
复制
发表时间：
2009
影响因子：
6.3
通讯作者：
Hajjar,Ihab
中科院分区：
文献类型：
--
作者：
Kim,DaeHyun;Hajjar,Ihab
In a small population-based cohort study of 348 adults aged 85 and older, Molander et al. showed that systolic blood pressure (SBP) less than 120 mmHg was significantly associated with mortality, after adjusting for age, sex, activities of daily living, Mini-Mental State Examination score, atrial fibrillation, and diabetes mellitus, and concluded that optimal SBP for this age group could be greater than 140 mmHg.(1) Although the authors noted the limitations to their study, we have concerns about the conclusions and their potential clinical implications.First, blood pressure in a subgroup of very old adults, particularly with heart failure, could be a reflection of failing physiological systems. Although a remote high blood pressure is a wellknown risk factor for heart failure (2) and cardiovascular events,(3, 4) lower blood pressure paradoxically portends poorer prognosis in patients with heart failure.(5, 6) Thus, the study sample appears to have included at least two distinct groups of very old adults—a group with heart failure, in which lower blood pressure is a marker of failing cardiovascular system and is associated with higher mortality, and a group without heart failure, in which high blood pressure might remain as a risk factor for cardiovascular morbidity and mortality. Such differential effect of blood pressure should be examined before the authors' conclusions are propagated in clinical practice. In addition, the authors did not measure blood pressure serially over the follow-up period. This would assess whether those with declining blood pressure are midway in their trajectory to death.
