Relationship of Blood Pressure With Mortality and Cardiovascular Events Among Hypertensive Patients aged >= 60 years in Rural Areas of China A Strobe-Compliant Study

摘要

The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of 150mmHg for the initiation of drug therapy and a therapeutic target of <150/90mmHg in patients 60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations.In the prospective cohort study, 5006 eligible hypertensive patients aged 60 years from rural areas of China were enrolled for the present analysis.The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989-3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855-3.935), incident CHD (HR: 3.263; 95% CI: 2.063-5.161), and stroke (HR: 2.334; 95% CI: 1.559-3.945) was still significantly increased in the group with BP of 140-149/<90mmHg.Older hypertensive patients with BP of 140-149/<90mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140-149/<90mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged 60 years in rural areas of China.