OBJECTIVES: To explore the relationship between systolic and diastolic bloo
d pressure and risk of 6-year, all-cause mortality in men and women age 65
to 84 versus those 85 and older.
DESIGN: A population-based longitudinal study.
SETTING: This study was conducted at four different sites: East Boston, Mas
sachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmon
t, North Carolina.
PARTICIPANTS: 12,802 community-dwelling persons age 65 and older.
MEASUREMENTS: Baseline measurements collected include demographics, self-re
ported chronic medical conditions, blood pressure measurements, medications
, health habits, and hospitalizations.
RESULTS: Unadjusted actuarial survival analyses show that men age 65 to 84
years with systolic blood pressure <130 mmHg have significantly lower morta
lity compared with those with systolic blood pressure <greater than or equa
l to>180 mmHg (P < .0001). In contrast, men 85 and older with systolic bloo
d pressure <greater than or equal to> 180 mmHg have significantly lower mor
tality compared with those with systolic blood pressure <130 mmHg (P < .000
1). In Cox proportional hazards analyses controlling for other predictors o
f survival, the hazard of death associated with each 10-mmHg increase in sy
stolic blood pressure is positively associated among men age 65 to 84 years
and negatively associated among men age 85 and older (Hazard ratio and 95%
confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86,
0.99) for older men). Among women age 65 to 84, the hazard of death signif
icantly increased with increase in systolic blood pressure (P < .0001), whi
le there was no relationship be tween level of systolic blood pressure and
survival in women 85 and older. Both men 65 to 84 years old and those 85 an
d older showed a negative relationship between diastolic blood pressure and
all-cause mortality (Hazard ratio 0.93, 95% CI (0.88-0.97) for men age 65-
84 years, and Hazard ratio 0.90, 95% CI 0.80-1.02 for men 85 and older).
CONCLUSION: In men age 85 and older, higher systolic blood pressure is asso
ciated with better survival.