MODIFICATION OF INCREASING SYSTOLIC BLOOD-PRESSURE IN THE ELDERLY DURING THE 1980S

The authors examined whether changing attitudes and approaches to modi fying blood pressure during the 1980s affected the previously describe d pattern of increasing systolic blood pressure in the elderly which c ontinues through the ninth decade of life. In 1982-1983, a door-to-doo r census identified 4,497 community-dwelling residents of East Boston, Massachusetts aged 65 and over, of whom 3,657 had baseline blood pres sure assessments. Follow-up blood pressure assessments occurred in 198 5-1986 and in 1988-1989. Cross-sectionally, the relation of age with s ystolic blood pressure was quadratic with levels predicted to increase until about age 84 after which they were lower among oldest-old survi vors. Longitudinally, mean age-sex-adjusted systolic blood pressure wa s 3.3 mmHg lower in 1985-1986 compared with 1982-1983 (95 percent conf idence interval (CI) 2.4-4.2 mmHg) and 10.6 mmHg lower in 1988-1989 co mpared with 1982-1983 (95 percent CI 9.5-11.7 mmHg). Utilization of an tihypertension medications increased over time and accounted for some, but not all, of the observed decreases in systolic blood pressure. La rge shifts occurred in the use of specific antihypertension medication s including increases in use of angiotensin converting enzyme inhibito rs and calcium entry blockers and decreases in use of thiazide diureti cs. Previously described trends for increasing systolic blood pressure in the elderly were reversed during the 1980s when the continued decl ine in cardiovascular mortality was greatest among the elderly.