Hypertension, Vol 22, 551-559, Copyright © 1993 by American Heart Association
RD Langer, MH Criqui, EL Barrett-Connor, MR Klauber and TG Ganiats
Higher diastolic pressure predicted better survival in men 75 years or
older in two prior analyses in the Rancho Bernardo population. Diastolic
change was implicated as a possible explanation. We studied this by
assessing survival according to blood pressure change in 795 men and women
aged 75 years and older at the time of a second measurement taken an
average of 11 years after the first, who were then followed for 5 years.
Sex-specific analyses compared participants with a diastolic decrease of 5
mm Hg or greater and participants with a systolic decrease of 10 mm Hg or
greater with those whose blood pressure levels did not change or increased.
In men, after adjustment for baseline pressure, a decrease in diastolic
pressure of 5 mm Hg or greater was associated with higher all-cause
mortality (relative risk, 2.33; 95% confidence interval, 1.39 to 3.91) and
cardiovascular mortality (3.13, 1.47 to 6.66). The mortality risk was
strongest in men who took antihypertensive medication and had a fall in
diastolic pressure (12.33, 2.73 to 55.72) compared with treated men whose
pressures did not decrease. Among men with isolated systolic hypertension,
those treated whose diastolic pressure remained stable had the best
survival. A systolic fall in men and a decrease in either diastolic or
systolic in women was not associated with poorer survival after adjustment
for baseline pressure. We conclude that a fall in diastolic pressure of 5
mm Hg was associated with poor survival in men after age 75. This risk was
strongest in men who took antihypertensive medication.
ARTICLES
Blood pressure change and survival after age 75
Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla 92093-0607.
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