Key result
Higher SBP links to ~9% lower mortality in octogenarians but not in fit individuals.
Why the study?
Randomized trials show blood pressure lowering benefits octogenarians, but observational studies link low systolic blood pressure with faster overall decline. This study examined factors influencing these associations.
Does higher systolic blood pressure improve survival and prevent cognitive or functional decline in very old adults?
Meta-Analysis (n=2,480)
Yes
Does higher systolic blood pressure improve survival and prevent cognitive or functional decline in very old adults?
Effect estimate: HR 0.91 (95% CI 0.88-0.95)
In the very old, higher systolic blood pressure is associated with lower all-cause mortality among those with frailty or cognitive impairment, but not in fit octogenarians, suggesting blood pressure targets should be individualized based on fitness.
OBJECTIVES: While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardiovascular diseases (CVD), and cognitive and physical fitness on the associations between SBP and health outcomes in the very old. METHODS: Five cohorts from the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included in a two-step individual participant data meta-analysis (IPDMA). We pooled hazard ratios (HR) from Cox proportional-hazards models for 5-year mortality and estimates of linear mixed models for change in cognitive and functional decline. Models were stratified by BP-lowering treatment, history of CVD, Mini-Mental State Examination scores, grip strength (GS) and body mass index (BMI). RESULTS: Of all 2480 participants (59.9% females, median 85 years), median baseline SBP was 149 mmHg, 64.3% used BP-lowering drugs and 47.3% had a history of CVD. Overall, higher SBP was associated with lower all-cause mortality (pooled HR 0.91 [95% confidence interval 0.88-0.95] per 10 mmHg). Associations remained irrespective of BP-lowering treatment, history of CVD and BMI, but were absent in octogenarians with above-median MMSE and GS. In pooled cohorts, SBP was not associated with cognitive and functional decline. CONCLUSION: While in the very old with low cognitive or physical fitness a higher SBP was associated with a lower all-cause mortality, this association was not evident in fit octogenarians. SBP was not consistently associated with cognitive and functional decline.
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Bogaerts et al. (2022) conducted a meta-analysis in Very old adults (octogenarians) (n=2,480). Higher systolic blood pressure vs. Lower systolic blood pressure was evaluated on 5-year all-cause mortality (HR 0.91, 95% CI 0.88-0.95). Higher systolic blood pressure was associated with lower all-cause mortality (HR 0.91 per 10 mmHg increase) in octogenarians, though this association was absent in cognitively and physically fit individuals.
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