[LB.01.01] DOES LEVEL OF FUNCTION, GRIP STRENGTH AND COMORBIDITY MODULATE ASSOCIATION OF HYPERTENSION WITH MORTALITY, IN 90 YEAR OLDS?. (September 2017)

• Record Type: Journal Article
• Authors: Bursztyn, M.; Jacobs, J.; Stessman, J.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523034.50784.fd
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Observational studies do not support association of hypertension with mortality in the oldest old, which however may be modulated by functional capacity. We attempt to determine the association between hypertension at age 90 and 5-year mortality, by functional capacity. Design and method: A prospective observational follow-up of an age-homogeneous, representative, community-dwelling cohort (480, 40.8% males, born 1920–1921), assessed at their homes. Hypertension is defined as treatment with antihypertensive medication, sitting blood pressure higher than 140 mmHg systolic or 90 mmHg diastolic. Subjects categorized as normotensive (NORMO), untreated hypertensive (NonTx-HTN), or treated hypertensive (Tx-HTN); assessment included Activities of Daily Living (ADL), handgrip strength; comorbidity. Results: Prevalence of NORMO, NonTx-HTN, and Tx-HTN was 12.3% (59/480), 12.7% (61/480) and 75% (360/480), with mean blood pressure of 124 ± 12/ 65 ± 7, 170 ± 54/76 ± 10, and 148 ± 29/ 70 ± 11 mmHg respectively. Higher rates of low education, depression, low physical activity, chronic heart failure, ischemic heart disease, chronic kidney disease were present among Tx-HTN. Five-year survival was lowest among Tx-HTN and highest among NonTx-HTN versus NORMO among all subjects (52%, 72%, 62%; p = 0.012), and among subjects with ADL-independence (64%, 91%, 74%; n = 265, p = 0.006), ADL-dependence (37%, 55%, 48%; n = 194, p = 0.335), high (above median) grip strength (66%, 85%, 83%; n = 227, p = 0.042), low (below median) grip strength (38%, 60%, 61%; n = 376, log rank p = 0.063), low comorbidity (64%, 84%, 70%; n = 219, p = 0.132) and high comorbidity (42%, 60%, 54%; n = 261, p = 0.121). Unadjusted mortality Hazards Ratios (HR) were higher for Tx-HTN (HR 1.38; 95%CI, 0.89–2.15) and lowest in NonTx-HTN (HR 0.7; 95%CI 0.37–1.31) compared to NORMO (HR 1.0). Similarly after adjusting for medical and functional covariables, adjusted HRs were higher for Tx-HTN (HR 1.39; 95%CI, 0.83–2.33), and lower for NonTx-HTN (HR 0.67; 95%CI 0.31–1.45) compared to NORMO (HR 1.0). Results were consistent in sample subsets according to ADL status, grip strength, and comorbidity and were unchanged after excluding subjects dying in the first follow-up year.; all-cause mortality data (2000–2015). Figure. No caption available. Conclusions: Untreated hypertension at age 90 was not associated with increased mortality risk among community dwelling elderly, irrespective of comorbidity, functional status, or muscle strength.