Kei Asayama1,2, Takayoshi Ohkubo1, Atsushi Satoh3, Sachiko Tanaka4, Aya Higashiyama5, Yoshitaka Murakami6, Michiko Yamada7, Shigeyuki Saitoh8, Akira Okayama9, Katsuyuki Miura3,10, Hirotsugu Ueshima3,10, Yoshihiro Miyamoto5, Tomonori Okamura11. 1. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo. 2. Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai. 3. Department of Public Health. 4. Medical Statistics, Shiga University of Medical Science, Otsu. 5. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita. 6. Department of Medical Statistics, Toho University School of Medicine, Tokyo. 7. Departments of Clinical Studies, Radiation Effects Research Foundation, Hiroshima. 8. Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences, Sapporo. 9. Research Institute for Lifestyle-Related Disease Prevention, Tokyo. 10. Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu. 11. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVE: There is little evidence to support an increased risk of blood pressure (BP) elevation among elderly individuals receiving antihypertensive drug treatment. METHODS: To clarify the impact on BP level and residual cardiovascular risk in treated elderly individuals, we analysed individual participant data of 26 133 residents aged 60-89 years from seven Japanese general populations and cross-classified participants by age category, 60-74 (young-old) versus 75-89 years (old-old), and by usage of antihypertensive medication at baseline survey (1980-1995). RESULTS: During a median follow-up period of 12.7 years, 2451 cardiovascular deaths were observed. Multivariable-adjusted hazard ratios of cardiovascular mortality in treated participants compared with untreated participants were 1.30 [95% confidence intervals, 1.16-1.46) and 1.35 (95% confidence interval, 1.16-1.56) in young-old and old-old participants, respectively. Irrespective of antihypertensive medication, the risk increase of total cardiovascular and stroke mortality with elevation of BP was significant among young-old (P ≤ 0.0013), but not significant among old-old participants (P ≥ 0.061). CONCLUSION: Although impact on BP was more evident among young-old than old-old individuals, clinicians who prescribe antihypertensive medication to elderly patients should consider that such patients require further monitoring.
OBJECTIVE: There is little evidence to support an increased risk of blood pressure (BP) elevation among elderly individuals receiving antihypertensive drug treatment. METHODS: To clarify the impact on BP level and residual cardiovascular risk in treated elderly individuals, we analysed individual participant data of 26 133 residents aged 60-89 years from seven Japanese general populations and cross-classified participants by age category, 60-74 (young-old) versus 75-89 years (old-old), and by usage of antihypertensive medication at baseline survey (1980-1995). RESULTS: During a median follow-up period of 12.7 years, 2451 cardiovascular deaths were observed. Multivariable-adjusted hazard ratios of cardiovascular mortality in treated participants compared with untreated participants were 1.30 [95% confidence intervals, 1.16-1.46) and 1.35 (95% confidence interval, 1.16-1.56) in young-old and old-old participants, respectively. Irrespective of antihypertensive medication, the risk increase of total cardiovascular and stroke mortality with elevation of BP was significant among young-old (P ≤ 0.0013), but not significant among old-old participants (P ≥ 0.061). CONCLUSION: Although impact on BP was more evident among young-old than old-old individuals, clinicians who prescribe antihypertensive medication to elderly patients should consider that such patients require further monitoring.