Some studies reported that excessive blood pressure (BP) control was not appropriate for older people, especially from the viewpoint of quality of life and maintaining sufficient blood flow for tissue perfusion. However, the lower limit of the target BP is still unclear, and there has not yet been a sufficient consensus. Therefore, we investigated the associations of BP levels with clinical events in older patients ~85 years old receiving home medical care. A total of 144 patients were included, who were followed for longer than 3 months in the Osaka Home Care Registry study, a prospective cohort study targeting older patients receiving home medical care in Japan. BP levels were divided into lower and higher groups based on the average systolic blood pressure (SBP). The main outcomes were clinical events, including hospitalizations, falls, and deaths during follow-up. As a result, the hospitalization rate in the SBP below 124 mmHg group was significantly higher than that in the SBP over 124 mmHg group. When comparing the clinical events between the two groups only in participants with hypertension, the same results were obtained. Furthermore, in Cox proportional hazards regression models adjusted by age, sex, and current diseases, the SBP below 124 mmHg group showed a significantly higher rate of required hospitalization (hazard ratio: 7.25, 95% confidence interval: 1.79–29.45). Thus, in older and very frail patients requiring home medical care, an SBP level below 124 mmHg could be a predictive marker of clinical events leading to hospitalization.
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Ministry of Health, Labor and Welfare. Vital statistics 2017. Tokyo: Ministry of Health, Labor and Welfare; 2017.
Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2014). Hypertens Res. 2014;37:253–390.
Amery A, Brixko P, Clement D, De Schaepdryver A, Fagard R, Forte J, et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet. 1985;325:1349–54.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program (SHEP). JAMA. 1991;265:3255–64.
Franco OH, Peeters A, Bonneux L, De Laet C. Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Hypertension. 2005;46:280–6.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.
Murakami Y, Hozawa A, Okamura T, Ueshima H. Relation of blood pressure and all-cause mortality in 180000 japanese participants pooled analysis of 13 cohort studies. Hypertension. 2008;51:1483–91.
Fukuhara M, Arima H, Ninomiya T, Hata J, Yonemoto K, Doi Y, et al. Impact of lower range of prehypertension on cardiovascular events in a general population: the Hisayama study. J Hypertens. 2012;30:893–900.
Okayama A, Kadowaki T, Okamura T, Hayakawa T, Ueshima H. Age-specific effects of systolic and diastolic blood pressures on mortality due to cardiovascular diseases among Japanese men (NIPPON DATA80). J Hypertens. 2006;24:459–62.
Angeli F, Reboldi G, Verdecchia P. Hypertension and the J-curve phenomenon: implications for tight blood pressure control. Hypertens Res. 2013;36:109–11.
Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs. standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years a randomized clinical trial. JAMA. 2016;315:2673–82.
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary. Hypertension. 2018;71:1269–324.
Mattila K, Haavisto M, Rajala S, Heikinheimo R. Blood pressure and five year survival in the very old. Br Med J. 1988;296:887–9.
Poortvliet RKE, De Ruijter W, De Craen AJM, Mooijaart SP, Westendorp RGJ, Assendelft WJJ, et al. Blood pressure trends and mortality: the Leiden 85-plus Study. J Hypertens. 2013;31:63–70.
Satish S, Freeman DH, Ray L, Goodwin JS. The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc. 2001;49:367–74.
Molander L, Lövheim H, Norman T, Nordström P, Gustafson Y. Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc. 2008;56:1853–9.
Rastas S, Pirttilä T, Viramo P, Verkkoniemi A, Halonen P, Juva K, et al. Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc. 2006;54:912–8.
Van Bemmel T, Gussekloo J, Westendorp RGJ, Blauw GJ. In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens. 2006;24:287–92.
Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE study. JAMA Intern Med. 2015;175:989–95.
Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.
Callisaya ML, Sharman JE, Close J, Lord SR, Srikanth VK. Greater daily defined dose of antihypertensive medication increases the risk of falls in older people—a population-based study. J Am Geriatr Soc. 2014;62:1527–33.
Mossello E, Pieraccioli M, Nesti N, Bulgaresi M, Lorenzi C, Caleri V, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015;175:578–85.
Peng J, Lu F, Wang Z, Zhong M, Sun L, Hu N, et al. Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study. J Am Med Dir Assoc. 2014;15:904–10.
Boal AH, Smith DJ, McCallum L, Muir S, Touyz RM, Dominiczak AF, et al. Monotherapy with major antihypertensive drug classes and risk of hospital admissions for mood disorders. Hypertension. 2016;68:1132–8.
Putignano E, Calcara L, Monteverde A, Curatolo G, Marchese M, Barbagallo Sangiorgi G. Arterial hypertension in the elderly. Cardiologia. 1994;39:585–9.
Yamamoto M, Kabayama M, Koujiya E, Huang Y, Akiyama M, Higami Y, et al. Factors associated with changes of care needs level in disabled older adults receiving home medical care: prospective observational study by Osaka Home Care Registry (OHCARE). Geriatr Gerontol Int. 2019;19:1198–205.
Ministry of Health, Labor and Welfare. Collection of laws and regulations related to certification for long-term care. Ministry of Health, Labor and Welfare; 2004.
Kuzuya M, Hasegawa J, Enoki H, Izawa S, Hirakawa Y, Hirose T, et al. Gender difference characteristics in the sociodemographic background of care recipients. Nippon Ronen Igakkai Zasshi. 2010;47:461–7. (in Japanese).
Ishizaki T, Kai I. Risk of acute hospitalization among long-term home care patients. Nippon Ronen Igakkai Zasshi. 2000;37:472–8. (in Japanese).
Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87:398–403.
Wilson RS, Rajan KB, Barnes LL, Hebert LE, Mendes De Leon CF, Evans DA. Cognitive aging and rate of hospitalization in an urban population of older people. J Gerontol A Biol Sci Med Sci. 2014;69:447–54.
Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association between incident dementia and risk of hospitalization. J Am Med Assoc. 2012;307:165–72.
Motzek T, Werblow A, Tesch F, Marquardt G, Schmitt J. Determinants of hospitalization and length of stay among people with dementia—an analysis of statutory health insurance claims data. Arch Gerontol Geriatr. 2018;76:227–33.
Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Blood pressure and survival in the oldest old. J Am Geriatr Soc. 2007;55:383–8.
Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, et al. Risk factors for the discontinuation of home medical care among low-functioning older patients. J Nutr Heal Aging. 2016;20:453–7.
Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, et al. Systolic blood pressure trajectory, frailty and all-cause mortality over 80 years of age. cohort study using electronic health records. Circulation. 2017;135:2357–68.
Morita M. Factors related to the long-term prognosis of home-based medical care subjects. Nippon Ronen Igakkai Zasshi. 2015;52:383–90. (in Japanese).
Sliedrecht A, den Elzen WP, Verheij TJ, Westendorp RG, Gussekloo J. Incidence and predictive factors of lower respiratory tract infections among the very elderly in the general population. The Leiden 85-plus Study. Thorax. 2008;63:817–22.
This study was supported by JSPS KAKENHI, Grant Numbers JP19K07888, JP19K11138, and JP17K12506. We sincerely thank all OHCARE study participants for their kind cooperation. We gratefully thank all staff at the cooperating clinics and former OHCARE research group members, Ms. Madoka Fukusaki, Ms. Kazuko Sakanoue, Ms. Takako Inoue, Ms. Ya Huang, and Ms. Yumiko Aoshima, as well as Ms. Tae Matsue for secretarial work.
This study was supported in part by grants-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (KK: 2510211, 15K08910; MK: 16K12336; MA: 976771).
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the ethics committee of the Osaka University Graduate School of Medicine (Approval Number: 2014-310).
Written informed consent was obtained from all participants or from a close relative.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Koujiya, E., Kabayama, M., Yamamoto, M. et al. Associations of blood pressure levels with clinical events in older patients receiving home medical care. Hypertens Res 44, 197–205 (2021). https://doi.org/10.1038/s41440-020-00538-5
- Blood pressure
- Home medical care