Defining thresholds for home blood pressure monitoring in octogenarians

Lucas S. Aparicio, Lutgarde Thijs, José Boggia, Lotte Jacobs, Jessica Barochiner, Augustine N. Odili, José Alfie, Kei Asayama, Paula E. Cuffaro, Kyoko Nomura, Takayoshi Ohkubo, Ichiro Tsuji, George S. Stergiou, Masahiro Kikuya, Yutaka Imai, Gabriel D. Waisman, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)

Abstract

To generate outcome-driven thresholds for home blood pressure (BP) in the elderly, we analyzed 375 octogenarians (60.3% women; 83.0 years [mean]) enrolled in the International Database on home BP in relation to cardiovascular outcome. Over 5.5 years (median), 155 participants died, 76 from cardiovascular causes, whereas 104, 55, 36, and 51 experienced a cardiovascular, cardiac, coronary, or cerebrovascular event, respectively. In 202 untreated participants, home diastolic in the lowest fifth of the distribution (≤65.1 mm Hg) compared with the multivariable-adjusted average risk was associated with increased risk of cardiovascular mortality and morbidity (hazard ratios [HRs], ≥1.96; P≤0.022), whereas the HR for cardiovascular mortality in the top fifth (≥82.0 mm Hg) was 0.37 (P=0.034). Among 173 participants treated for hypertension, the HR for total mortality in the lowest fifth of systolic home BP (<126.9 mm Hg) was 2.09 (P=0.020). In further analyses of home BP as continuous variable (per 1-SD increment), higher diastolic BP predicted lower cardiovascular mortality and morbidity and cardiac and coronary risk (HR≤0.65; P≤0.039) in untreated participants. In those treated, cardiovascular morbidity was curvilinearly associated with systolic home BP with nadir at 148.6 mm Hg and with a 1.45 HR (P=0.046) for a 1-SD decrease below this threshold. In conclusion, in untreated octogenarians, systolic home BP ≥152.4 and diastolic BP ≤65.1 mm Hg entails increased cardiovascular risk, whereas diastolic home BP ≥82 mm Hg minimizes risk. In those treated, systolic home BP <126.9 mm Hg was associated with increased total mortality with lowest risk at 148.6 mm Hg.

Original languageEnglish
Pages (from-to)865-873
Number of pages9
JournalHypertension
Volume66
Issue number4
DOIs
Publication statusPublished - 2015 Oct 11

Keywords

  • aged
  • aged 80 and over
  • blood pressure monitoring
  • cardiovascular diseases
  • home
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Defining thresholds for home blood pressure monitoring in octogenarians'. Together they form a unique fingerprint.

Cite this