Hypertension and 5-Year Mortality among 85-Year-Olds: The Jerusalem Longitudinal Study

Abstract: Objective: Hypertension is among the most common chronic complaints of older people. Among very old people with common co morbidities, it remains uncertain whether the benefits of long-term treatment seen among younger people, are also observed. Our objective was to assess the relationship of blood pressure (BP) at age 85 with 5-year all-cause mortality. Design: A longitudinal prospective cohort study, of an age-homogenous, representative sample born 1920–1921. Setting: Community-based home assessments. Participants: West Jerusalem residents (1159) born 1920–1921, all aged age 85 during 2005–2006, currently enrolled in the Jerusalem Longitudinal Study. Intervention: None. Measurements: Comprehensive geriatric assessment of numerous health variables. BP was determined as the average of 6 measurements, from 2 separate home visits. Hypertension (HTN) defined as either treatment with antihypertensive medications, or blood pressure >140 mm Hg systolic, or >90 mm Hg. The study outcome was all-cause 5-year mortality. Mortality data were collected from the National Ministry of Interior. Results: One hundred and nine (9.4%) were normotensive, 152 (13.1%) untreated, and 898 (77.5%) treated hypertensives. Treatment rate was 78%, and controlled hypertension rate 38%. During 5 years 328 (28.3%) patients died. Kaplan-Meier survival curves and log rank analysis showed no difference in mortality between normotensive, untreated and treated hypertensive subjects according to sex. Treated subjects with controlled Systolic Blood Pressure (SBP) had lowest survival rate of 67%, P = .029. Continuous SBP yielded a hazard ratio (HR) for mortality of 1.00, (95% CI 0.95–1.01), after adjusting in Cox proportional hazard models for sex, heart failure, physical activity, self-rated health, diabetes, coronary and cerebrovascular diseases, smoking and antihypertensive therapy. Results were unaffected after excluding 114 deaths within the first 2-years of follow-up. Similar results were found when examining BP either as a dichotomous variable, according to treatment, or pulse pressure. Conclusions: Raised SBP was not associated with increased 5-year mortality among a representative cohort of community-dwelling 85-year-olds. Indeed, before adjustment for co morbidities, subjects with controlled SBP tended to have a worse survival. [Copyright &y& Elsevier]