Blood pressure, frailty status, and all-cause mortality in elderly hypertensives; The Nambu Cohort Study.
Blood pressure
Frailty
Mortality
Journal
Hypertension research : official journal of the Japanese Society of Hypertension
ISSN: 1348-4214
Titre abrégé: Hypertens Res
Pays: England
ID NLM: 9307690
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
21
07
2021
accepted:
15
09
2021
revised:
14
09
2021
pubmed:
16
10
2021
medline:
28
1
2022
entrez:
15
10
2021
Statut:
ppublish
Résumé
Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70-84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34-43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12-11.40), <140 mmHg/Frailty 4.72 (1.67-16.90), and ≥140 mmHg/Frailty 3.56 (1.16-13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.
Identifiants
pubmed: 34650194
doi: 10.1038/s41440-021-00769-0
pii: 10.1038/s41440-021-00769-0
pmc: PMC8668433
doi:
Substances chimiques
Antihypertensive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
146-154Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s).
Références
Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa S-YY, Okamura T, et al. Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women. Hypertens Res. 2012;35:947–53. https://doi.org/10.1038/hr.2012.87
doi: 10.1038/hr.2012.87
pubmed: 22739419
Arima H, Tanizaki Y, Yonemoto K, Doi Y, Ninomiya T, Hata J, et al. Impact of blood pressure levels on different types of stroke: the Hisayama study. J Hypertens. 2009;27:2437–43. https://doi.org/10.1097/HJH.0b013e328330e882
doi: 10.1097/HJH.0b013e328330e882
pubmed: 19657282
Ueshima H, Iimura O, Iida M, Okayama A, Sawai K, Minowa M. Impact of elevated blood pressure on mortality from all causes, cardiovascular diseases, heart disease and stroke among Japanese: 14 year follow-up of randomly selected population from Japanese - Nippon data 80. J Hum Hypertens. 2003;17:851–57. https://doi.org/10.1038/sj.jhh.1001602
doi: 10.1038/sj.jhh.1001602
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet (Lond, Engl). 2016;387:957–67. https://doi.org/10.1016/S0140-6736(15)01225-8
doi: 10.1016/S0140-6736(15)01225-8
Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertens. 2014;32:2285–95. https://doi.org/10.1097/HJH.0000000000000378
doi: 10.1097/HJH.0000000000000378
pubmed: 25255397
Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665 https://doi.org/10.1136/bmj.b1665
doi: 10.1136/bmj.b1665
pubmed: 19454737
pmcid: 2684577
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13. https://doi.org/10.1016/s0140-6736(02)11911-8
doi: 10.1016/S0140-6736(02)11911-8
pubmed: 12493255
Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37:253–390. https://doi.org/10.1038/hr.2014.20
doi: 10.1038/hr.2014.20
pubmed: 24705419
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481. https://doi.org/10.1038/s41440-019-0284-9
doi: 10.1038/s41440-019-0284-9
pubmed: 31375757
Xue Q-L. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27:1–15. https://doi.org/10.1016/j.cger.2010.08.009
doi: 10.1016/j.cger.2010.08.009
pubmed: 21093718
pmcid: 3028599
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95. https://doi.org/10.1503/cmaj.050051
doi: 10.1503/cmaj.050051
pubmed: 16129869
pmcid: 1188185
Ramsay SE, Arianayagam DS, Whincup PH, Lennon LT, Cryer J, Papacosta AO, et al. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart. 2015;101:616–22. https://doi.org/10.1136/heartjnl-2014-306472
doi: 10.1136/heartjnl-2014-306472
pubmed: 25480883
Matsuoka M, Inoue T, Shinjo T, Miiji A, Tamashiro M, Oba K, et al. Cardiovascular risk profile and frailty in Japanese outpatients: the Nambu Cohort Study. Hypertens Res. 2020;43:817–23. https://doi.org/10.1038/s41440-020-0427-z
doi: 10.1038/s41440-020-0427-z
pubmed: 32203449
Yanagita I, Fujihara Y, Eda T, Tajima M, Yonemura K, Kawajiri T, et al. Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients. J Diabetes Investig. 2018;9:419–25. https://doi.org/10.1111/jdi.12698
doi: 10.1111/jdi.12698
pubmed: 28556518
Rådholm K, Festin K, Falk M, Midlöv P, Mölstad S, Östgren CJ. Blood pressure and all-cause mortality: a prospective study of nursing home residents. Age Ageing. 2016;45:826–32. https://doi.org/10.1093/ageing/afw122
doi: 10.1093/ageing/afw122
pubmed: 27496923
Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: a randomized clinical trial. JAMA. 2016;315:2673–82. https://doi.org/10.1001/jama.2016.7050
doi: 10.1001/jama.2016.7050
pubmed: 27195814
pmcid: 4988796
Warwick J, Falaschetti E, Rockwood K, Mitnitski A, Thijs L, Beckett N, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placeb. BMC Med. 2015;13:78 https://doi.org/10.1186/s12916-015-0328-1
doi: 10.1186/s12916-015-0328-1
pubmed: 25880068
pmcid: 4404571
Arai H, Satake S. English translation of the Kihon Checklist. Geriatr Gerontol Int. 2015;15:518–9. https://doi.org/10.1111/ggi.12397
doi: 10.1111/ggi.12397
pubmed: 25828791
Satake S, Senda K, Hong Y-J, Miura H, Endo H, Sakurai T, et al. Validity of the Kihon Checklist for assessing frailty status. Geriatr Gerontol Int. 2016;16:709–15. https://doi.org/10.1111/ggi.12543
doi: 10.1111/ggi.12543
pubmed: 26171645
Benetos A. Hypertension: a Companion to Braunwald’s Heart Disease - 3rd ed. In Philadelphia, PA: Elsevier; 2018. p. 396–404.
Ferrucci L, Cavazzini C, Corsi A, Bartali B, Russo CR, Lauretani F, et al. Biomarkers of frailty in older persons. J Endocrinol Investig. J Endocrinol Invest 2002;25(10 Suppl):10–5.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet (Lond, Engl). 2013;381:752–62. https://doi.org/10.1016/S0140-6736(12)62167-9
doi: 10.1016/S0140-6736(12)62167-9
Ninomiya T, Zoungas S, Neal B, Woodward M, Patel A, Perkovic V, et al. Efficacy and safety of routine blood pressure lowering in older patients with diabetes: results from the ADVANCE trial. J Hypertens. 2010;28:1141–9.
doi: 10.1097/HJH.0b013e328338a89c
pubmed: 20486273
JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31:2115–27. https://doi.org/10.1291/hypres.31.2115
doi: 10.1291/hypres.31.2115
Ogihara T, Saruta T, Rakugi H, Matsuoka H, Shimamoto K, Shimada K, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertens (Dallas, Tex 1979). 2010;56:196–202. https://doi.org/10.1161/HYPERTENSIONAHA.109.146035
doi: 10.1161/HYPERTENSIONAHA.109.146035
SPS3 Study Group, Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet (London, England). 2013; 382: 507–15. https://doi.org/10.1016/S0140-6736(13)60852-1
SPRINT Research Group, Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015; 373: 151109120153006. https://doi.org/10.1056/NEJMoa1511939
Wei Y, Jin Z, Shen G, Zhao X, Yang W, Zhong Y, et al. Effects of Intensive Antihypertensive Treatment on Chinese Hypertensive Patients Older Than 70 Years. J Clin Hypertens. 2013;15:420–27. https://doi.org/10.1111/jch.12094
doi: 10.1111/jch.12094
Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol - Ser A Biol Sci Med Sci. 2007;62:738–43. https://doi.org/10.1093/gerona/62.7.738
doi: 10.1093/gerona/62.7.738
Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, et al. Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records. Circulation. 2017;135:2357–68. https://doi.org/10.1161/CIRCULATIONAHA.116.026687
doi: 10.1161/CIRCULATIONAHA.116.026687
pubmed: 28432148
pmcid: 5472195
Douros A, Tölle M, Ebert N, Gaedeke J, Huscher D, Kreutz R, et al. Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study. Eur Heart J. 2019;40:2021–28. https://doi.org/10.1093/eurheartj/ehz071
doi: 10.1093/eurheartj/ehz071
pubmed: 30805599
Okumiya K, Matsubayashi K, Wada T, Fujisawa M, Osaki Y, Doi Y, et al. A U-shaped association between home systolic blood pressure and four-year mortality in community-dwelling older men. J Am Geriatr Soc. 1999;47:1415–21. https://doi.org/10.1111/j.1532-5415.1999.tb01559.x
doi: 10.1111/j.1532-5415.1999.tb01559.x
pubmed: 10591234
Delgado J, Masoli JAH, Bowman K, Strain WD, Kuchel GA, Walters K, et al. Outcomes of Treated Hypertension at Age 80 and Older: Cohort Analysis of 79,376 Individuals. J Am Geriatr Soc. 2017;65:995–1003. https://doi.org/10.1111/jgs.14712
doi: 10.1111/jgs.14712
pubmed: 28039870
Lv Y Bin, Gao X, Yin ZX, Chen HS, Luo JS, Brasher MS, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: Community based, longitudinal prospective study. BMJ. 2018; 361. https://doi.org/10.1136/bmj.k2158
Kabayama M, Kamide K, Gondo Y, Masui Y, Nakagawa T, Ogawa M, et al. The association of blood pressure with physical frailty and cognitive function in community-dwelling septuagenarians, octogenarians, and nonagenarians: the SONIC study. Hypertens Res. 2020;43:1421–29. https://doi.org/10.1038/S41440-020-0499-9
doi: 10.1038/S41440-020-0499-9
pubmed: 32641853