Abstract
Numerous trials have shown that lowering blood pressure (BP) reduces cardiovascular risk and mortality, yet data about the impact of BP on cardiovascular death risk in patients aged ≥80 years with acute myocardial infarction (AMI) are sparse. This study explored the prognostic value of BP for cardiovascular death during the first 48 h after admission following AMI among patients aged ≥80 years. A total of 1005 patients ≥80 years with AMI were enrolled. Average BP parameters, including systolic, diastolic, and pulse BP, over the first 48 h after admission were calculated. The end point was cardiovascular death. Receiver operating curve (ROC) analysis was used to identify whether BP was relevant to cardiovascular death. The relationship between BP levels and cardiovascular death was evaluated by Cox regression models. ROC analysis showed that average diastolic blood pressure (aDBP), but not systolic and pulse BP, was relevant to cardiovascular death, and the optimal cutoff was 65 mmHg. During the 2.9-year follow-up, patients who died from a cardiovascular cause had lower aDBP levels than those who did not (p = 0.002). Patients with aDBP <65 mmHg had a 1.5-fold higher incidence of cardiovascular death than those with aDBP ≥65 mmHg (35.9% vs. 24.0%; p < 0.001). In multivariable regression analysis, low aDBP remained a strong and independent predictor of cardiovascular death (adjusted hazard ratio 1.907; 95% CI 1.303–2.792). aDBP was independently associated with cardiovascular death in patients aged ≥80 years with AMI, suggesting that aDBP may be a useful index to predict worse outcome in these patients.
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References
Hua Q, Fan L, Li J, Joint Committee for Guideline Revision. 2019 Chinese guideline for the management of hypertension in the elderly. J Geriatr Cardiol. 2019;16:67–99.
Lopes RD, Gharacholou SM, Holmes DN, Thomas L, Wang TY, Roe MT, et al. Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. Am J Med. 2015;128:582–90.
Kvakkestad KM, Abdelnoor M, Claussen PA, Eritsland J, Fossum E, Halvorsen S. Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: a prospective cohort study. Eur Heart J Acute Cardiovasc Care. 2016;5:243–52.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C. 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.
Muller M, Smulders YM, de Leeuw PW, Stehouwer CD. Treatment of hypertension in the oldest old: a critical role for frailty? Hypertension. 2014;63:433–41.
Abudureyimu MZJ, Jin XJ, Cui XT, Hu K, Ge JB. The impact of hypertension on left ventricular diastolic dysfunction and arterial stiffness in the elderly: a cross‑sectional study. Cardiol. 2020;5:186–93.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–115.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
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.
Post Hospers G, Smulders YM, Maier AB, Deeg DJ, Muller M. Relation between blood pressure and mortality risk in an older population: role of chronological and biological age. J Intern Med. 2015;277:488–97.
Mouhat B, Putot A, Hanon O, Eicher JC, Chague F, Beer JC, et al. Low systolic blood pressure and mortality in elderly patients after acute myocardial infarction. J Am Heart Assoc. 2020;9:e013030.
Streit S, Poortvliet RKE, Gussekloo J. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus Study. Age Ageing. 2018;47:545–50.
Asayama K, Ohkubo T, Satoh A, Tanaka S, Higashiyama A, Murakami Y, et al. Cardiovascular risk and blood pressure lowering treatment among elderly individuals: evidence for cardiovascular prevention from observational cohorts in Japan. J Hypertens. 2018;36:410–8.
Zhang WL, Cai J. STEP to blood pressure management of elderly hypertension: evidence from Asia. Hypertens Res. 2022;45:576–82.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Nat Rev Cardiol. 2012;9:620–33.
Jin JL, Cao YX, Zhang HW, Sun D, Hua Q, Li YF, et al. Lipoprotein(a) and cardiovascular outcomes in patients with coronary artery disease and prediabetes or diabetes. Diabetes Care. 2019;42:1312–8.
Liu HH, Cao YX, Jin JL, Hua Q, Li YF, Guo YL, et al. Lipoprotein (a), hypertension, and cardiovascular outcomes: a prospective study of patients with stable coronary artery disease. Hypertens Res. 2021;44:1158–67.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group; 1999.
Black HR, Curb JD, Pressel S, Probstfield JL,StamlerJ, eds. 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). SHEP Cooperative Research Group. JAMA. 1991;265:3255–64.
Peart SS, Brennan PJ, Broughton P, Dollery SC, Hudson MF, Lever AF, et al. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ. 1992;304:405–12.
Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.
Forette F, Seux ML, Staessen JA, Thijs L, Birkenhager WH, Babarskiene MR, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998;352:1347–51.
King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharm. 1999;48:643–8.
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.
Bohm M, Ferreira JP, Mahfoud F, Duarte K, Pitt B, Zannad F, et al. Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial. Eur Heart J. 2020;41:1673–83.
Protogerou AD, Safar ME, Iaria P, Safar H, Le Dudal K, Filipovsky J, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension. 2007;50:172–80.
McEvoy JW, Chen Y, Rawlings A, Hoogeveen RC, Ballantyne CM, Blumenthal RS, et al. Diastolic blood pressure, subclinical myocardial damage, and cardiac events: implications for blood pressure control. J Am Coll Cardiol. 2016;68:1713–22.
Kai H, Kimura T, Fukuda K, Fukumoto Y, Kakuma T, Furukawa Y, et al. Impact of low diastolic blood pressure on risk of cardiovascular death in elderly patients with coronary artery disease after revascularization—the CREDO-Kyoto Registry Cohort-1. Circ J. 2016;80:1232–41.
Kai H, Katoh A, Harada H, Niiyama H, Furukawa Y, Kimura T, et al. Low blood pressure and cardiovascular events in diabetic patients with coronary artery disease after revascularization: the CREDO-Kyoto registry cohort-1. Hypertens Res. 2020;43:715–23.
Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev. 2008;88:1009–86.
Westerhof N, Boer C, Lamberts RR, Sipkema P. Cross-talk between cardiac muscle and coronary vasculature. Physiol Rev. 2006;86:1263–308.
Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019;124:1045–60.
Funding
This work was supported by the Capital Health Development Fund (201614035) and CAMS Major Collaborative Innovation Project (2016-I2M-1-011) awarded to J-JL, MD, PhD.
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Zhang, M., Yan, XN., Hong, LF. et al. Clinical impact of blood pressure on cardiovascular death in patients 80 years and older following acute myocardial infarction: a prospective cohort study. Hypertens Res 45, 1882–1890 (2022). https://doi.org/10.1038/s41440-022-01030-y
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DOI: https://doi.org/10.1038/s41440-022-01030-y
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