Shiwani Mahajan1,2, Jianlei Gu3,4, Cesar Caraballo1,2, Yuan Lu1,2, Erica S Spatz1,2, Hongyu Zhao3,5, MaoZhen Zhang6,7, NingLing Sun8, Xin Zheng9, Hui Lu3,10, Hong Yuan11, Zheng J Ma3,5,12, Harlan M Krumholz1,2,13. 1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. 2. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. 3. Shanghai Jiao Tong University-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China. 4. Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Shanghai, China. 5. Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut. 6. iKang Healthcare Group, Inc, Shanghai, China. 7. Department of Cardiology, Xinhua Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China. 8. Department of Hypertension at Heart Center, People's Hospital, Peking University, Beijing, China. 9. National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 10. Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China. 11. The Third Xiangya Hospital of Central South University, Changsha, China. 12. Beijing Li-Heng Medical Technologies, Ltd, Beijing, China. 13. Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
Abstract
BACKGROUND: Age is known to be associated with the prevalence and pathophysiology of hypertension. However, there is little information on whether age stands as a good proxy for the specific hemodynamic profile of an individual with elevated blood pressure (BP), which could be important in the selection of therapy. DESIGN: This is a cross-sectional study. SETTING: People who underwent a noninvasive, hemodynamic assessment using impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between January 2012 and October 2018. PARTICIPANTS: We included 116,851 individuals, aged 20 to 80 years. MAIN OUTCOMES AND MEASURES: Relationship between age and hemodynamic parameters (cardiac index, systemic vascular resistance index [SVRI]), among individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg). RESULTS: Final study population included 45,082 individuals with elevated BP: 29,194 men and 15,888 women with a mean (±SD) age of 48 (±13) and 54 (±12) years, respectively. Cardiac index was negatively associated with age with an adjusted, per decade decrease of 0.17 (95% confidence interval [CI] = 0.17-0.18) L/min/m2 in men and 0.24 (95% CI = 0.23-0.25) L/min/m2 in women. SVRI was positively associated with age with an adjusted, per-decade increase of 174.2 (95% CI = 168.8-179.7) dynes·s·cm-5 ·m2 in men and 214.1 (95% CI = 204.3-223.8) dynes·s·cm-5 ·m2 in women. However, there was substantial overlap in the distribution of these parameters across different age groups in both sexes. CONCLUSIONS: In this large study, we observed that cardiac index decreased and SVRI increased with age among individuals with elevated BP. Even though there was a general trend with age, we observed heterogeneity within age strata, suggesting that age alone is inadequate to indicate the hemodynamic profile for an individual. J Am Geriatr Soc 68:1520-1528, 2020.
BACKGROUND: Age is known to be associated with the prevalence and pathophysiology of hypertension. However, there is little information on whether age stands as a good proxy for the specific hemodynamic profile of an individual with elevated blood pressure (BP), which could be important in the selection of therapy. DESIGN: This is a cross-sectional study. SETTING:People who underwent a noninvasive, hemodynamic assessment using impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between January 2012 and October 2018. PARTICIPANTS: We included 116,851 individuals, aged 20 to 80 years. MAIN OUTCOMES AND MEASURES: Relationship between age and hemodynamic parameters (cardiac index, systemic vascular resistance index [SVRI]), among individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg). RESULTS: Final study population included 45,082 individuals with elevated BP: 29,194 men and 15,888 women with a mean (±SD) age of 48 (±13) and 54 (±12) years, respectively. Cardiac index was negatively associated with age with an adjusted, per decade decrease of 0.17 (95% confidence interval [CI] = 0.17-0.18) L/min/m2 in men and 0.24 (95% CI = 0.23-0.25) L/min/m2 in women. SVRI was positively associated with age with an adjusted, per-decade increase of 174.2 (95% CI = 168.8-179.7) dynes·s·cm-5 ·m2 in men and 214.1 (95% CI = 204.3-223.8) dynes·s·cm-5 ·m2 in women. However, there was substantial overlap in the distribution of these parameters across different age groups in both sexes. CONCLUSIONS: In this large study, we observed that cardiac index decreased and SVRI increased with age among individuals with elevated BP. Even though there was a general trend with age, we observed heterogeneity within age strata, suggesting that age alone is inadequate to indicate the hemodynamic profile for an individual. J Am Geriatr Soc 68:1520-1528, 2020.