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Blood pressure and long-term mortality in older patients: results of the Fiesole Misurata Follow-up Study

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Abstract

Background

Optimal blood pressure (BP) control can prevent major adverse health events, but target values are still controversial, especially in older patients with comorbidities, frailty and disability.

Aims

To evaluate mortality according to BP values in a cohort of older adults enrolled in the Fiesole Misurata Study, after a 6-year follow-up.

Methods

Living status as of December 31, 2016 was obtained in 385 subjects participating in the Fiesole Misurata Study. Patients' characteristics were analysed to detect predictors of mortality. At baseline, all participants had undergone office BP measurement and a comprehensive geriatric assessment.

Results

After a 6-year follow-up, 97 participants had died (25.2%). After adjustment for comorbidities and comprehensive geriatric assessment, mortality was significantly lower for SBP 140–159 mmHg as compared with 120–139 mmHg (HR 0.54, 95% CI 0.33–0.89). This result was also confirmed in patients aged 75 + (HR 0.49, 95% CI 0.29–0.85), and in those with disability (HR 0.36, 95% CI 0.15–0.86) or taking antihypertensive medications (HR 0.49, 95% CI 0.28–0.86).

Discussion

An intensive BP control may lead to greater harm than benefit in older adults. Indeed, the European guidelines recommend caution in BP lowering in older patients, especially if functionally compromised, to minimize the risk of hypotension-related adverse events.

Conclusions

After a 6-year follow-up, mortality risk was lower in participants with SBP 140–159 mmHg as compared with SBP 120–139 mmHg, in the overall population and in the subgroups of subjects aged 75 + , with a disability or taking anti-hypertensive medications.

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Funding

This work was conducted with contribution of the Tuscany Region. The authors thank the Specialization Schools of Pharmacology and of Geriatrics for questionnaire administration and data recording and Fiesole Municipality for data collection.

Author information

Author notes

  1. Giulia Rivasi and Ersilia Lucenteforte have contributed equally to this work.

Authors and Affiliations

  1. University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50149, Florence, Italy

    Giulia Rivasi, Giada Turrin, Matteo Bulgaresi, Nicola Nesti, Antonella Giordano, Martina Rafanelli, Mauro Di Bari & Andrea Ungar

  2. Department of Neuroscience, Psychology, Pharmacology & Children Health (NEUROFARBA), University of Florence, Florence, Italy

    Ersilia Lucenteforte, Niccolò Lombardi, Roberto Bonaiuti, Alfredo Vannacci & Alessandro Mugelli

  3. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Ersilia Lucenteforte

  4. Epidemiology Unit, Local Health Unit 10, Florence, Italy

    Daniela Balzi

  5. Department of Geriatric Medicine, Nottingham University Hospitals Trust NHS, Nottingham, UK

    Tahir Masud

Authors
  1. Giulia Rivasi
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  2. Ersilia Lucenteforte
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  3. Giada Turrin
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  4. Daniela Balzi
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  5. Matteo Bulgaresi
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  6. Nicola Nesti
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  7. Antonella Giordano
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  8. Martina Rafanelli
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  9. Niccolò Lombardi
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  12. Alessandro Mugelli
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  13. Mauro Di Bari
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  14. Tahir Masud
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  15. Andrea Ungar
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Contributions

Study conception and design by Andrea Ungar and Alessandro Mugelli. Material preparation, data collection and analysis were performed by Andrea Ungar, Ersilia Lucenteforte, Daniela Balzi, Matteo Bulgaresi, Nicola Nesti, Antonella Giordano, Martina Rafanelli, Niccolò Lombardi, Alfredo Vannacci, Alessandro Mugelli, Mauro Di Bari and Andrea Ungar. The first draft of the manuscript was written by Giulia Rivasi, Giada Turrin and Andrea Ungar and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrea Ungar.

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The authors have no conflict of interest to declare.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Comitato Etico AOU Careggi) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Rivasi, G., Lucenteforte, E., Turrin, G. et al. Blood pressure and long-term mortality in older patients: results of the Fiesole Misurata Follow-up Study. Aging Clin Exp Res 32, 2057–2064 (2020). https://doi.org/10.1007/s40520-020-01534-y

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  • DOI: https://doi.org/10.1007/s40520-020-01534-y

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