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Abstract: FR-PO366

Pharmacologic Control of Arterial Hypertension and Risk of All-Cause Mortality in Older Adults

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Douros, Antonios, Charite Universitätsmedizin Berlin, Berlin, Germany
  • van der Giet, Markus, Charite Universitätsmedizin Berlin, Berlin, Germany
  • Ebert, Natalie, Charite Universitätsmedizin Berlin, Berlin, Germany
  • Gaedeke, Jens, Dept. of Nephrology, Charité, Berlin, Germany
  • Kuhlmann, Martin K., Vivantes Klinikum im Friedrichshain, Berlin, Germany
  • Schneider, Alice, Charite Universitätsmedizin Berlin, Berlin, Germany
  • Schaeffner, Elke, Charite Universitätsmedizin Berlin, Berlin, Germany

Group or Team Name

  • Berlin Initiative Study (BIS) Team
Background

Hypertension is highly prevalent in older adults and can increase the risk of mortality. Real world data on the effects of disease control in this age group are scarce. Thus, the objective of this population-based analysis was to assess whether pharmacologic control of hypertension has an impact on the risk of all-cause mortality in patients ≥70 yrs.

Methods

All patients were participants in the Berlin Initiative Study (BIS). Demographics, lifestyle factors, medication use, and comorbidities were ascertained in face-to-face interviews. Mortality was assessed using health insurance data including the exact date of death. Cox prop. hazards models yielded adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause mortality associated with systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg ('good' disease control) compared to SBP ≥140 mmHg and/or DBP ≥90 mmHg ('poor' disease control). In secondary analyses we assessed the risk of all-cause mortality after stratifying by age (70-79 vs ≥80 yrs) and previous cardiovascular (CV) events.

Results

Among the 2069 participants of the BIS, 1628 (79%) were treated with antihypertensive drugs at baseline. Of those, 636 (39%) showed good disease control (mean age 81 yrs, 51% female) and 992 (61%) poor disease control (mean age 81 yrs, 53% female). Baseline characteristics were comparable between patients with good and poor disease control except for previous myocardial infarction (23% vs 15%) and albuminuria (23% vs 33%). During a follow-up of 8853 person-yrs, 469 patients died. Compared with poor disease control, good disease control was associated with an increased risk of all-cause mortality (HR, 1.27; 95% CI, 1.04-1.55). This effect was augmented in patients ≥80 yrs (HR, 1.41; 95% CI, 1.13-1.76) and patients with previous CV events (HR, 1.68; 95% CI, 1.19-2.38) (Figure).

Conclusion

Reducing BP below 140/90 mmHg could increase the risk of mortality in older adults, in particular among octogenarians and patients with previous CV event.

Funding

  • Private Foundation Support