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Associations of blood pressure levels with clinical events in older patients receiving home medical care

Abstract

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.

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Acknowledgements

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.

Funding sources

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).

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Correspondence to Kei Kamide.

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This study was approved by the ethics committee of the Osaka University Graduate School of Medicine (Approval Number: 2014-310).

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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

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Keywords

  • Blood pressure
  • Elderly
  • Hypertension
  • Home medical care

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