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Original Study
Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality?

https://doi.org/10.1016/j.jamda.2016.12.076Get rights and content

Abstract

Objective

To determine the association between hypertension at age 90 years, treatment, and 5-year mortality.

Design

A prospective observational study of a representative community-dwelling birth cohort (born 1920–1921) by the Jerusalem Longitudinal Study (1990–2015).

Setting

Home-assessment.

Participants

480 subjects aged 90, examined 2010–2011.

Measurements and Main Outcome: Hypertension was defined as treatment with antihypertensive medication, and/or sitting blood pressure (BP) > 140 mmHg systolic or >90 mmHg diastolic. Subjects were categorized as normotensive (NORMO), untreated hypertensive (NonTx-HTN), and treated hypertensive (Tx-HTN); assessment included activities of daily living (ADL), handgrip strength, and all-cause mortality (2010–2015).

Results

NORMO, NonTx-HTN, and Tx-HTN prevalence was 12.3% (59/480), 12.7% (61/480), and 75% (360/480). Tx-HTN had higher rates of low education, depression, low physical activity, chronic heart failure, ischemic heart disease, chronic kidney disease. Five-year survival was lowest among Tx-HTN and highest among NonTx-HTN versus NORMO among all subjects (51%, 72%, 61%; P = .01), and subgroups with ADL independence (64%, 91%, 74%; n = 265, P = .01), ADL dependence (37%, 55%, 48%; n = 194, P = .36), high grip strength (66%, 85%, 83%; n = 227, P = .04), low grip strength (38%, 60%, 61%; n = 149, P = .06), low comorbidity (64%, 84%, 70%; n = 219, P = .13), and high comorbidity (42%, 60%, 54%; n = 257, P = .12). Unadjusted mortality hazards ratios (HR) were higher for Tx-HTN [HR 1.38; 95% confidence interval (CI) 0.89–2.15] versus NonTx-HTN (HR 0.7; 95% CI 0.37–1.31) compared to NORMO (HR 1.0). After adjusting for medical and functional covariates, adjusted HRs were higher for Tx-HTN (HR 1.39; 95% CI 0.83–2.33) versus NonTx-HTN (HR 0.67; 95% CI 0.31–1.45) compared to NORMO (HR 1.0). Findings were consistent in subsets according to ADL status, grip strength, and comorbidity.

Conclusions

Untreated hypertension at age 90 years was not associated with increased mortality risk among community-dwelling elderly, irrespective of comorbidity, functional status, or muscle strength.

Section snippets

Study Population

The study population is part of the Jerusalem Longitudinal Study (1990–2015), a prospective observational longitudinal study previously described.16, 17 The sample frame is the birth cohort born June 1, 1920, through May 31, 1921, resident in Western Jerusalem, all of whom were eligible for inclusion. There were no exclusion criteria. Subjects were randomly chosen from the national electoral register, and the sample has been proven to be representative, as shown by similar morbidity, mortality,

Results

A total of 480 subjects aged 90 years were assessed, among whom the prevalence of NORMO, NonTx-HTN, and Tx-HTN was 12.3% (59/480), 12.7% (61/480), and 75% (360/480), respectively, with mean BP of 124 ± 12/65 ± 7, 169 ± 54/76 ± 10, and 148 ± 29/70 ± 11 mmHg, respectively. Subjects with Tx-HTN were more likely to be depressed, less educated, sedentary, to have heart failure, ischemic heart disease, chronic kidney disease, lower total cholesterol, low-density lipoprotein (LDL), and hemoglobin. The

Discussion

This study describes the association between BP at age 90 years among a representative community dwelling sample and subsequent 5-year survival, after accounting for antihypertensive treatment, common comorbidities, functional status, and hand grip strength. The primary finding is a negative one. Compared to normotensives, untreated raised BP levels were not significantly associated with an increased mortality risk or reduced survival among nonagenarians. Indeed a recurring trend to emerge from

Conclusions and Implications

This observational study among a representative community-dwelling cohort failed to find a significant association between hypertensive status at age 90 years and 5-year mortality. Indeed, a tendency toward improved survival and reduced risk of mortality was observed in nontreated hypertensives, after adjusting for associated comorbidity, functional status, and muscle strength. Treating hypertension beyond the age of 90 years should remain a highly individualized decision, and despite the

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  • Cited by (0)

    J. Stessman and M. Bursztyn contributed equally to the study.

    This work was supported by funds from the Ministry of Senior Citizens of the State of Israel, and Eshel—the Association for the Planning and Development of Services for the Aged in Israel. No support was offered by any commercial venture. These funds were used exclusively to support the research effort, primarily as salaries to ancillary staff. No research funds were received by any author of this paper. The sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review, or approval of the manuscript.

    The authors declare no conflicts of interest.

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