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Lian Q, Jafar TH, Allen JC, Ma S, Malhotra R. Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study. J Aging Health 2021; 34:674-683. [PMID: 34814767 DOI: 10.1177/08982643211055245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with mortality among older adults in Singapore. METHODS Association of SBP and DBP measured in 2009 for 4443 older adults (69.5±7.4 years; 60-97 years) participating in a nationally representative study with mortality risk through end-December 2015 was assessed using Cox regression. RESULTS Higher mortality risk was observed at the lower and upper extremes of SBP and DBP. With SBP of 100-119 mmHg as the reference, multivariable mortality hazard ratios [HRs (95% confidence interval)] were SBP <100 mmHg: 2.41 (1.23-4.72); SBP 160-179 mmHg: 1.51 (1.02-2.22); and SBP ≥180 mmHg: 1.78 (1.12-2.81). With DBP of 70-79 mmHg as the reference, HRs were DBP <50 mmHg: 2.41 (1.28-4.54) and DBP ≥110 mmHg: 2.16 (1.09-4.31). DISCUSSION Management of high blood pressure among older adults will likely reduce their mortality risk. However, the association of excessively low SBP and DBP values with mortality risk needs further evaluation.
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Affiliation(s)
- Qian Lian
- 37581Singapore General Hospital, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,199688Duke Global Health Institute, Duke University, Durham, NC, USA
| | - John C Allen
- Centre for Quantitative Medicine, 121579Duke-NUS Medical School, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, 50107Ministry of Health, Singapore
| | - Rahul Malhotra
- Program in Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Centre for Ageing Research and Education, 121579Duke-NUS Medical School, Singapore
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Ahmadi SF, Streja E, Zahmatkesh G, Streja D, Kashyap M, Moradi H, Molnar MZ, Reddy U, Amin AN, Kovesdy CP, Kalantar-Zadeh K. Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population. J Am Med Dir Assoc 2015; 16:933-9. [PMID: 26363864 PMCID: PMC4636955 DOI: 10.1016/j.jamda.2015.07.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 01/08/2023]
Abstract
Traditional risk factors of cardiovascular death in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcomes in the geriatric population, but in an opposite direction. Some degrees of elevated BMI, serum cholesterols, and BP are reportedly associated with lower, instead of higher, risk of death among the elderly. This phenomenon is termed "reverse epidemiology" or "risk factor paradox" (such as obesity paradox) and is also observed in a variety of chronic disease states such as end-stage renal disease requiring dialysis, chronic heart failure, rheumatoid arthritis, and AIDS. Several possible causes are hypothesized to explain this risk factor reversal: competing short-term and long-term killers, improved hemodynamic stability in the obese, adipokine protection against tumor necrosis factor-α, lipoprotein protection against endotoxins, and lipophilic toxin sequestration by the adipose tissue. It is possible that the current thresholds for intervention and goal levels for such traditional risk factors as BMI, serum cholesterol, and BP derived based on younger populations do not apply to the elderly, and that new levels for such risk factors should be developed for the elderly population. Reverse epidemiology of conventional cardiovascular risk factors may have a bearing on the management of the geriatric population, thus it deserves further attention.
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Affiliation(s)
- Seyed-Foad Ahmadi
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Department of Population Health and Disease Prevention, Program in Public Health, University of California Irvine, Irvine, CA
| | - Elani Streja
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Golara Zahmatkesh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA
| | - Dan Streja
- Department of Medicine, Providence Medical Institute, West Hills, CA
| | - Moti Kashyap
- Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Hamid Moradi
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN
| | - Uttam Reddy
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA
| | - Alpesh N Amin
- Department of Medicine, University of California Irvine Medical Center, Orange, CA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA; Department of Population Health and Disease Prevention, Program in Public Health, University of California Irvine, Irvine, CA; Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA; Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA.
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Gutiérrez-Misis A, Sánchez-Santos MT, Banegas JR, Castell MV, González-Montalvo JI, Otero A. Walking speed and high blood pressure mortality risk in a Spanish elderly population. J Hum Hypertens 2015; 29:566-72. [PMID: 25880596 DOI: 10.1038/jhh.2015.32] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023]
Abstract
This study analyzed the relationship between blood pressure and all-cause mortality according to objectively measured walking speed in a Mediterranean population-based sample of older persons. We used data from the longitudinal 'Peñagrande' Cohort Study, initiated in 2008 in a sex- and age-stratified random sample of 1250 people aged ⩾65 years living in Madrid (Spain). A total of 814 individuals participated in the first study wave. The average of two standardized blood pressure readings was used. Walking speed was measured over a 3-m walk and classified as faster (⩾0.8 m s(-1)) or slower. A total of 314 individuals were slower walkers, 475 were faster walkers and 25 did not complete the walk test. Cox proportional hazards models stratified by walking speed were used to assess the association between blood pressure and all-cause death. Non-linear relationship between BP and mortality was explored by a restricted cubic spline analysis. There were 171 deaths from study entry through 31 March 2013. Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mmHg were associated with higher mortality than blood pressure values above 140 and 90 mm Hg, respectively, but this association reached statistical significance only for systolic blood pressure and only in the slower walkers. In conclusion, systolic blood pressure levels <140 mm Hg were found associated with higher risk of total mortality among slower walkers in an old Spaniard population cohort.
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Affiliation(s)
| | - M T Sánchez-Santos
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J R Banegas
- 1] Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain [2] IdiPAZ, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - M V Castell
- 1] Centro de Salud Dr Castroviejo, Primary Care, IdiPAZ, Madrid, Spain [2] IdiPAZ, Madrid, Spain
| | - J I González-Montalvo
- 1] IdiPAZ, Madrid, Spain [2] Department of Geriatrics, La Paz University Hospital, Madrid, Spain
| | - A Otero
- 1] Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain [2] IdiPAZ, Madrid, Spain
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