Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 25, 2023
Date Accepted: May 5, 2024
Optimal Systolic Blood Pressure for the Prevention of All-cause and Cardiovascular Disease Mortality in Older Adults with Hypertension: A Nationwide Population-based Cohort Study
ABSTRACT
Background:
Target systolic blood pressure (SBP) levels for older adults with hypertension varies across countries, leading to challenges in determining the appropriate SBP level.
Objective:
This study aimed to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension.
Methods:
This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged ≥65 years, newly diagnosed with hypertension, who underwent the National Health Insurance Service health check-up in 2003–2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than two health checkups during the period of follow-up until 2020. We categorized the average SBP levels into six categories in 10 mmHg increments from <120 mmHg to ≥160 mmHg; 130–140 mmHg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortality and subgroup analysis was conducted by age group (65–74 years and ≥75 years).
Results:
A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4,273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130–139 mmHg, individuals that fell into the other SBP categories, excluding those with SBP 120–129 mmHg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65–74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged ≥75 years.
Conclusions:
SBP levels within the range of 120–139 mmHg were associated with the lowest all-cause and CVD mortality rates among Korean older adults with hypertension. It is recommended to reduce SBP to <140 mmHg with 120mmHg as the minimum value for SBP for Korean older adults with hypertension. Additionally, more strict SBP management is required for older adults aged 65–74 years.
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