How does blood pressure level influence 5-year survival in the middle and late old age subjects?

Objective. To study the influence of blood pressure (BP) on 5-year survival in the middle and late old age subjects living in Moscow and the Moscow region.

Design and methods. Two hundred and sixty-three patients (24 % of men) aged 75-98 (mean age 87) years after programmed stay at the Russian gerontology clinical research center were included in the prospective observational study. We analyzed values of systolic, diastolic and pulse BP at admission to hospital and at discharge, and their dynamics during hospitalization in all patients and separately in age subgroups of 75-89 and ≥ 90 years. The follow-up period was 5 years. Endpoint included death from any cause.

Results. During the follow-up period (median 3,82 years), 94 (35,7 %) patients died. Degree of BP decrease during hospitalization had no impact on survival in the very old patients. Only BP at hospitalization (reflecting the long existing “habitual” BP level) had prognostic value. In patients over 75 years, systolic BP (SBP) at hospitalization < 140 mm Hg was associated with increased 5-year total mortality risk by 54 % (relative risk (RR) 1,54; 95 % confidence interval (CI) 1,02-2,33; p = 0,041), and the highest mortality rate was in patients with SBP < 110 mm Hg. Kaplan-Meier analysis did not show association between the BP level and 5-year survival in patients aged 75-89 years. In long-living subgroup, 5-year mortality risk was higher in patients with SBP < 140 mm Hg and pulse BP (PBP) < 55 mm Hg, however, according to the multivariate analysis, PBP level was an independent predictor of 5-year total mortality (RR 2,63; 95 % CI 1,28-5,40; p = 0,009). In long-livers, the highest mortality rate was in patients with SBP < 110 mm Hg and/or PBP < 40 mm Hg.

Conclusions. In patients over 75 years, low SBP is associated with increased 5-year total mortality risk on 54 %, and in long-livers subgroup, low PBP increases mortality risk by 2,6 times. Diastolic BP has no prognostic value.

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