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Blood pressure and all-cause mortality: a prospective study of nursing home residents
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
Department of Clinical Sciences in Malmö, Center for Primary Health Care Research Lund University, Malmö, Sweden.
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2016 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: To explore the natural course of blood pressure development and its relation to mortality in a nursing home cohort.

Methods: A cohort of 406 nursing home residents in south east Sweden was followed prospectively for 30 months. Participants were divided into four groups based on systolic blood pressure (SBP) at baseline. Data were analysed using a Cox regression model with all-cause mortality as the outcome measurement; paired Student t-tests were used to evaluate blood pressure development over time.

Results: During follow-up, 174 (43%) people died. Participants with SBP <120 mmHg had a hazard ratio for mortality of 1.56 (95% confidence interval, 1.08–2.27) compared with those with SBP 120–139 mmHg, adjusted for age and sex. Risk of malnutrition or present malnutrition was most common in participants with SBP <120 mmHg; risk of malnutrition or present malnutrition estimated using the Mini Nutritional Assessment was found in 78 (71%). The levels of SBP decreased over time independent of changes in anti-hypertensive medication.

Conclusions: In this cohort of nursing home residents, low SBP was associated with increased all-cause mortality. SBP decreased over time; this was not associated with altered anti-hypertensive treatment. The clinical implication from this study is that there is a need for systematic drug reviews in elderly persons in nursing homes, paying special attention to those with low SBP.

Place, publisher, year, edition, pages
Oxford University Press, 2016.
Keyword [en]
older people, prospective study, nursing home, hypertension, hypotension, all-cause mortality
National Category
Family Medicine Other Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-121283DOI: 10.1093/ageing/afw122OAI: oai:DiVA.org:liu-121283DiVA: diva2:853090
Note

Funding agencies| Health Research Council in south east Sweden (FORSS-8888, FORSS-11636 and FORSS-31811); the County of Östergötland (LIO-11877, LIO-31321 and LIO-79951); the Family Janne Elgqvist Foundation; King Gustaf V and Queen Victoria Freemason Foundation.

At the time for thesis presentation publication was in status: Manuscript

Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2016-08-04Bibliographically approved
In thesis
1. Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
Open this publication in new window or tab >>Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.

Methods

This thesis was based on four different studies:

  • The ELSA85 study of 85 years old in Linköping, Sweden
  • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
  • The prospective SHADES study of nursing home residents, mean age 85 years.
  • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).

Results

The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).

Conclusion

Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1466
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences Family Medicine
Identifiers
urn:nbn:se:liu:diva-121286 (URN)10.3384/diss.diva-121286 (DOI)978-91-7519-030-3 (print) (ISBN)
Public defence
2015-10-09, Belladonna, ingång 78, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2015-09-18Bibliographically approved

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Rådholm, KarinFestin, KarinFalk, MagnusÖstgren, Carl Johan
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Division of Community MedicineFaculty of Medicine and Health SciencesResearch & Development Unit in Local Health Care"Primary Health Care in Motala"
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Age and Ageing
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