TY  - JOUR
AU  - Lee, Jae Jun
AU  - Lee, Kyung Hee
PY  - 2024
DA  - 2024/6/11
TI  - Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study
JO  - JMIR Public Health Surveill
SP  - e52182
VL  - 10
KW  - aged
KW  - blood pressure
KW  - cardiovascular diseases
KW  - hypertension
KW  - mortality
KW  - older adults
KW  - geriatric
KW  - elderly
KW  - cardiovascular
KW  - Korea
KW  - Korean
KW  - insurance
KW  - cohort study
KW  - systolic
KW  - risk
KW  - aging
KW  - health outcome
AB  - Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2024/1/e52182
UR  - https://doi.org/10.2196/52182
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38861307
DO  - 10.2196/52182
ID  - info:doi/10.2196/52182
ER  -