Abstract 2936: Prognostic Orthostatic Blood Pressure Increase in 80 Aged and Older Subjects
Background: The prognostic implication of blood pressure (BP) in the very elderly population may be quite different from those in the younger population. We prospectively investigated the predictors of total mortality and cardiovascular mortalities in the very elderly population aged 80 years or more.
Methods: We have conducted multicenter prospective study, the TOVEP study, which recruited 523 very elderly outpatients aged ≥80 years (mean±SD age: 84±5.3 years). The study subjects had normal activity of daily living at the baseline, and they were followed prospectively for an average duration of 33±14 months. Main outcomes were all-cause (total) and cardiovascular mortalities. Orthostatic hypertension (OHT) and hypotension (OHypo) were defined as systolic blood pressure increase of 20mmHg (n=47) or more and decrease of 20mmHg (n=49) or more from supine to standing position.
Results: Seventy-one deaths including 25 cardiovascular deaths occurred during this follow-up period. Cardiovascular mortality tended to be higher in the highest BP groups (Systolic BP <140mmHg: 6.0%, 140≤, <160mmHg: 6.4%, ≥160mmHg: 11.0%; diastolic BP: <70mmHg: 4.9%, 70≤, <90mmHg: 6.6%, ≥90mmHg: 14.3%, p<0.1). Diabetes, hyperlipidemia, and smoking were not associated with cardiovascular mortality. OHT group was significantly higher in the cardiovascular mortality than non-OHT group (17.1 vs. 5.9%, p=0.007). There was not significant difference in the cardiovascular mortality between OHypo and non-OHypo groups (9.8 vs. 6.7%). In a Cox regression analysis model controlling for age, body mass index and BP levels, OHT was an independent risk factor for cardiovascular mortality (hazard ratio 4.13, 95% CI 1.65 to 10.34, p=0.002).
Conclusion: Orthostatic hypertension was the stronger predictor of cardiovascular death among all conventional cardiovascular risk factors including blood pressure level in the very elderly subject age 80 years or more.