Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population - the prospective STEPHY II Study

Aim To prospectively study the relationship between blood pressure levels a nd subsequent cardiovascular morbidity and mortality in a population aged 6 5 years and older. Methods Participants of the 1992 baseline survey of the population-based St arnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elder ly (STEPHY, 394 men and 588 women above age 65) were followed up for 3 year s. Total mortality was assessed by official death data. Cardiovascular morb idity, that is, the occurrence of non-fatal events (new cases of acute myoc ardial infarction, angina pectoris, stroke, and heart failure) could be ass essed in 681 of the 863 survivors by a second interview and analysis of gen eral practitioners' records. The mortality and morbidity risks were compare d for hypertensives (baseline blood pressure greater than or equal to 160/9 5 mmHg or antihypertensive treatment) and non-hypertensives. Results During follow-up a total of 55 men and 64 women died resulting in a 2.7-year cumulative mortality in this population of 12%. Mortality was hig her in men (14%) than in women (11%). Hypertensives had no increased risk o f death compared to non-hypertensives (adjusted relative risk (RR) = 0.92: 95% CI: 0.48-1.76 for men and RR = 1.36: 95% CI 0.67-2.78 for women). This was confirmed in age-stratified analyses. However, among survivors hyperten sion was associated with a significantly higher occurrence of non-fatal car diovascular events. After controlling for potentially confounding baseline conditions, the relative risk for any event (RR = 1.44; 95% CI: 1.04-2.0) a nd, in particular, of acute myocardial infarction (RR = 5.5; 95% CI: 1.6-18 .7) was raised among hypertensives. Higher rates for angina pectoris (RR = 1.4; 95% CI: 0.9-2.4) and heart failure (RR 1.7; 95% CI: 0.9-2.9) were of b orderline significance. Positive risk associations were confined to the age group 65 to 75 years and not detected at higher ages. Conclusion This study demonstrates for a Central European population older than 65 years the impact of hypertension as a risk factor for cardiovascula r and cerebrovascular morbidity. To address the issue that risk of death sh owed no significant relationship to blood pressure, a longer follow-up peri od might be necessary. (C) 1999 European Society of Cardiology.