BACKGROUND AND PURPOSE: Epidemiological studies have shown mixed findings on the association between hypertension and stroke in the oldest old. Heterogeneity of the populations under study may underlie variation in outcomes. We examined whether the level of physical and cognitive function moderates the association between blood pressure and stroke. METHODS: We included 513 subjects aged 85 years old from the population-based Leiden 85-plus Study. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure were measured at baseline. Activities of daily living and Mini-Mental State Examination were assessed to estimate level of physical and cognitive function, respectively. Five-year risk of stroke was estimated with Cox regression analysis. RESULTS: In the entire cohort, there were no associations between various measures of blood pressure and risk of stroke except for the inverse relation between pulse pressure and stroke risk (hazard ratio [HR], 0.80 [95% confidence interval [CI], 0.66-0.98]). Among subjects with impaired physical functioning, higher systolic blood pressure (HR, 0.74 [95% CI, 0.59-0.92]), mean arterial pressure (HR: 0.68 [95% CI, 0.47-0.97]), and pulse pressure (HR, 0.71 [95% CI, 0.55-0.93]) were associated with reduced risk of stroke. Likewise, among subjects with impaired cognitive functioning, higher systolic blood pressure was associated with reduced risk of stroke (HR, 0.80 [95% CI, 0.65-0.98]). In subjects with unimpaired cognitive functioning, higher diastolic blood pressure (HR: 1.98 [95% CI, 1.21-3.22]) and mean arterial pressure (HR, 1.70 [95% CI, 1.08-2.68]) were associated with higher risk of stroke. CONCLUSIONS: Our findings suggest that impaired physical and cognitive function moderates the association between blood pressure and stroke.
BACKGROUND AND PURPOSE: Epidemiological studies have shown mixed findings on the association between hypertension and stroke in the oldest old. Heterogeneity of the populations under study may underlie variation in outcomes. We examined whether the level of physical and cognitive function moderates the association between blood pressure and stroke. METHODS: We included 513 subjects aged 85 years old from the population-based Leiden 85-plus Study. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure were measured at baseline. Activities of daily living and Mini-Mental State Examination were assessed to estimate level of physical and cognitive function, respectively. Five-year risk of stroke was estimated with Cox regression analysis. RESULTS: In the entire cohort, there were no associations between various measures of blood pressure and risk of stroke except for the inverse relation between pulse pressure and stroke risk (hazard ratio [HR], 0.80 [95% confidence interval [CI], 0.66-0.98]). Among subjects with impaired physical functioning, higher systolic blood pressure (HR, 0.74 [95% CI, 0.59-0.92]), mean arterial pressure (HR: 0.68 [95% CI, 0.47-0.97]), and pulse pressure (HR, 0.71 [95% CI, 0.55-0.93]) were associated with reduced risk of stroke. Likewise, among subjects with impaired cognitive functioning, higher systolic blood pressure was associated with reduced risk of stroke (HR, 0.80 [95% CI, 0.65-0.98]). In subjects with unimpaired cognitive functioning, higher diastolic blood pressure (HR: 1.98 [95% CI, 1.21-3.22]) and mean arterial pressure (HR, 1.70 [95% CI, 1.08-2.68]) were associated with higher risk of stroke. CONCLUSIONS: Our findings suggest that impaired physical and cognitive function moderates the association between blood pressure and stroke.
Authors: B Gwen Windham; Michael E Griswold; Seth Lirette; Anna Kucharska-Newton; Randi E Foraker; Wayne Rosamond; Josef Coresh; Stephen Kritchevsky; Thomas H Mosley Journal: J Gerontol A Biol Sci Med Sci Date: 2015-09-25 Impact factor: 6.053
Authors: Nicholas M Pajewski; Jeff D Williamson; William B Applegate; Dan R Berlowitz; Linda P Bolin; Glenn M Chertow; Marie A Krousel-Wood; Nieves Lopez-Barrera; James R Powell; Christianne L Roumie; Carolyn Still; Kaycee M Sink; Rocky Tang; Clinton B Wright; Mark A Supiano Journal: J Gerontol A Biol Sci Med Sci Date: 2016-01-11 Impact factor: 6.053
Authors: Jeff D Williamson; Mark A Supiano; William B Applegate; Dan R Berlowitz; Ruth C Campbell; Glenn M Chertow; Larry J Fine; William E Haley; Amret T Hawfield; Joachim H Ix; Dalane W Kitzman; John B Kostis; Marie A Krousel-Wood; Lenore J Launer; Suzanne Oparil; Carlos J Rodriguez; Christianne L Roumie; Ronald I Shorr; Kaycee M Sink; Virginia G Wadley; Paul K Whelton; Jeffrey Whittle; Nancy F Woolard; Jackson T Wright; Nicholas M Pajewski Journal: JAMA Date: 2016-06-28 Impact factor: 56.272
Authors: Michelle C Odden; Chenkai Wu; Michael G Shlipak; Bruce M Psaty; Ronit Katz; William B Applegate; Tamara Harris; Anne B Newman; Carmen A Peralta Journal: J Gerontol A Biol Sci Med Sci Date: 2016-05-03 Impact factor: 6.053
Authors: Michelle C Odden; Andrew E Moran; Pamela G Coxson; Carmen A Peralta; Lee Goldman; Kirsten Bibbins-Domingo Journal: J Am Geriatr Soc Date: 2016-05 Impact factor: 5.562