Stage 3 hypertension at diagnosis was associated with a higher risk of cardiovascular mortality compared to stage 1, with a stronger effect in patients aged 60-69 years (HR 1.56 in males, HR 1.48 in females) than in those aged 70-85 years.
Cohort (n=125,978)
Does stage 3 hypertension at diagnosis increase cardiovascular and all-cause mortality compared to stage 1 hypertension in elderly patients?
Stage 3 hypertension at diagnosis is associated with a higher risk of cardiovascular and all-cause mortality in elderly patients, with a more pronounced relative risk increase in those aged 60-69 compared to those aged 70-85.
Hazard Ratio: 1.56 (95% CI 1.41–1.72)
BACKGROUND: Hypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses. METHODS: This cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex. RESULTS: 28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41-1.72) and 1.29(1.21-1.37) for males aged 60-69 years, 1.25(1.14-1.36) and 1.13(1.06-1.20) for males aged 70-85 years, 1.48(1.32-1.67) and 1.29(1.19-1.40) for females aged 60-69 years, and 1.19(1.10-1.29) and 1.08(1.01-1.15) for females aged 70-85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71-0.93 RERI: 0.59, 95% CI: 0.09-1.07) and females (HR: 0.81, 95% CI: 0.70-0.93 RERI: 0.66, 95% CI: 0.10-1.23). CONCLUSIONS: Diagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60-69 years compared with those with age at diagnosis of 70-85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.
Wu et al. (Tue,) conducted a cohort in Hypertension (n=125,978). Stage 3 hypertension at diagnosis vs. Stage 1 hypertension at diagnosis was evaluated on Cardiovascular mortality (males aged 60-69 years) (HR 1.56, 95% CI 1.41-1.72). Stage 3 hypertension at diagnosis was associated with a higher risk of cardiovascular mortality compared to stage 1, with a stronger effect in patients aged 60-69 years (HR 1.56 in males, HR 1.48 in females) than in those aged 70-85 years.