Blood pressure and risk of myocardial infarction in elderly men and women:the Rotterdam Study

Objective To study the association between blood pressure and risk of myoca rdial infarction in elderly subjects. Design Prospective cohort study. Setting The Rotterdam Study, a Dutch population-based study. Participants 6004 men and women aged greater than or equal to 55 years. Main outcome measures Fatal or non-fatal myocardial infarction (n = 190) du ring a 4-year follow-up. Results After excluding participants using blood pressure-lowering medicati on and participants with a history of myocardial infarction, increasing lev els of systolic blood pressure (SBP) were associated with increasing risk o f first myocardial infarction (P for trend < 0.0001), The relative risk (RR ) for an SEP of 160 mmHg or higher was 5.7 (95% confidence interval (CI) 1. 9-17.1) compared with an SEP below 120 mmHg. Increasing diastolic blood pre ssure (DBP) was also associated with increasing risk of first myocardial in farction, with the RR reaching 2.5 (95% CI 1.4-4.5) in subjects with values of 80-90 mmHg compared with values below 70 mmHg (P for trend < 0,05), Ana lyses in subjects aged 70 years and over showed that the positive associati ons between SEP and DBP and risk of first myocardial infarction remained at older age. Conclusion These findings in a relatively healthy cohort of elderly subject s do not provide evidence for a J- or U- shaped relation between SEP and DB P and risk of first myocardial infarction, They suggest that the risk of fi rst myocardial infarction increases with increasing level of systolic and d iastolic blood pressure and that this relationship persists into older age. J Hypertens 1999, 17:1373-1378 () Lippincott Williams & Wilkins.