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Lower on-treatment blood pressures linked to death and cognitive decline in over-85s

Lower systolic blood pressures with antihypertensive treatment have been linked to increased rates of all-cause mortality and accelerated cognitive decline among patients aged 85 and over.

Researchers from Switzerland and the Netherlands investigated the link between low blood pressure and patient outcomes in those taking antihypertensive treatments, compared with those who are not.

Their small study found that for patients prescribed antihypertensive therapy, all-cause mortality and rate of cognitive decline significantly increased with decreasing systolic blood pressure.

The paper, published in University of Oxford’s Age and Ageing, analysed data from a cohort study with a five-year follow-up, carried out in Leiden, the Netherlands.

In total, the team investigated data from 570 individuals aged 85 and over, of which 249 (43.7%) were prescribed antihypertensive therapy at baseline.

Participants prescribed and not prescribed antihypertensive therapy were similar in all other aspects except for a higher prevalence of CVD in those prescribed antihypertensives.

Researchers found that those prescribed antihypertensive therapy with a systolic blood pressure above 170 mmHg had the lowest risk of all-cause mortality, while those below 140 mmHg had the highest risk.

They also noted that those prescribed antihypertensives showed a faster rate of decline in the mental state examination as blood pressure decreased, despite the rate not being significantly faster for the non-medicated patients.

The paper said: ‘In this population-based cohort of individuals aged 85 years with a five year follow-up, we found lower systolic blood pressure was associated with higher all-cause mortality and faster annual cognitive decline in participants prescribed antihypertensive therapy.’

The authors called the findings ‘concerning’ and said: ‘For clinicians, this study raises the question of what the optimal target blood pressure level is for 85-year-old frail patients.’

NICE currently sets a higher target blood pressure for patients aged 80 and over (below 150/90 mmHg) who are treated for hypertension, when compared with those under 80 (below 140/90 mmHg). 

Readers' comments (9)

  • Dear All,
    Time to exception report?
    Paul C

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  • Azeem Majeed

    t’s a small observational study (570 participants) and so it is difficult to draw firm conclusions. The findings are though in line with those from other observational studies of blood pressure in older people.

    Clinical guidelines don’t generally provide specific advice on treating high blood pressure in the very elderly (85 and over), partly because there is limited evidence from clinical trials in this group. Clinicians should therefore tailor their treatment in the very elderly for each individual, taking into account factors such as frailty, cognitive function and predicted life expectancy.

    It’s an area where we need further research and clearer guidance from bodies such as NICE.

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  • Being elderly also linked with death and cognitive deterioration.Infact if something else doesn't get you cognitive deterioration and death are inevitable.The length of life dose not mean the extra life is happy or healthy.Quality over quantity every time.The states desire to be at the top of the league promotes length of life at all cost even if the extra years are sad and miserable, the highlight of your isolated life seeing the GP to get your BP checked and moaning in the waiting room how it was better in my day.

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  • Vinci Ho

    To me , this is no difference to relaxing HbA1c targets in elderly type 2 diabetics . 64 -75mmol/mol(8-9%) in those over 80 years old .
    This should be considered as a ‘medical common sense’.

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  • Isn't being over 85 linked with cognitive decline and death???

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  • I'll agree that it is better to keep the bp even slightly higher around 150/90 or up to 160 systolic rather than trying to lower as it does seem to increase the risk of adverse event. BP does seem to rise with age and there is a risk of medicalizing and overtreating. We shouldn't stick to NICE guideline blindly even if we are paid for these.

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  • First do no harm! We sometime overtreat, overdiagnose,medicalise, to the detriment of our patient based on recommendations of 'expert's and guidelines.

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  • in old days we were taught 100+your age is your normal systolic blood pressure. diastolic bp is important to control. in 1980's studies showed lowering systolic bp is as important as diastolic and we started treating every one irrespective of age.
    no doubt thinks will change again in future.

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  • From treating people to a target of 140/150 to a much higher target of 170 would be a massive shift. I wonder what the biological basis of this is? It can't just be a reduction in falls as surely they'd have reported that.
    Obviously we await bigger trials, but I will certainly be taking this into account for my 85 pluses.

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