Decreasing Blood Pressure in Older Patients

A 20-year cohort analysis of medical records in the UK revealed that blood pressure (BP) decreased for more than a decade before death in patients dying at 60 years and older. The analysis included 46 634 participants dying aged at least 60 years (51.7% female; mean age at death 82.4 years), from 2010 to 2014; and compared BP slopes from 10 to 3 years before death for 20 207 participants who died, with 20 207 birth-year and sex-matched participants surviving longer than 9 years. Systolic BP (SBP) and diastolic BP (DBP) peaked 18 to 14 years before death and then decreased progressively. Mean changes in SBP from peak values ranged from −8.5 mm Hg for those dying aged 60 to 69 years to −22.0 mm Hg for those dying at 90 years or older; overall, 64.0% of individuals had SBP changes of greater than −10 mm Hg. Decreases in BP appeared linear from 10 to 3 years before death, with steeper decreases in the last 2 years of life. Decreases in SBP from 10 to 3 years before death were present in individuals not treated with antihypertensive medications, but mean yearly changes were steepest in patients with hypertension (−1.58 vs −0.70 mm Hg), dementia (−1.81 vs −1.41 mm Hg), heart failure (−1.66 vs −1.37 mm Hg), and late-life weight loss. Another population-based study of 303 patients who underwent autopsy in the US found that those with microinfarcts did not differ on baseline BP compared with those with no microinfarcts; however, participants with subcortical microinfarcts had a greater annual decline of BP. The presence of microinfarcts is associated with cognitive decline. Source: https://jamanetwork.com/