Clinical outcomes with a systolic blood pressure lower than 120 mmHg in older patients with high disease burden

Figures & data

Table 1. Baseline patient characteristics, N = 380.

Age, years Mean ± SD	75.5 ± 8.7
Male gender N (%)	179 (47.1%)
Caucasian N (%)	366 (96.3%)
African–American N (%)	5 (1.3%)
Hispanic N (%)	7 (1.8%)
Other N (%)	2 (0.5%)
HTN N (%)	357 (93.9%)
Hyperlipidemia N (%)	276 (72.6%)
Diabetes mellitus N (%)	193 (50.8%)
Obesity N (%)	211 (55.5%)
Cancer N (%)	96 (25.3%)
CHF N (%)	97 (25.5%)
CVA N (%)	31 (8.1%)
PVD N (%)	96 (25.3%)
CAD N (%)	123 (32.4%)
Atrial fibrillation N (%)	95 (25%)
Pulmonary disease N (%)	106 (27.9%)
Chronic liver disease N (%)	16 (4.2%)
Proteinuria mg/g, Median [IQR]	100 [22, 300]
Hemoglobin g/dL, Mean ± SD	12.5 ± 1.8
Albumin g/dL, Mean ± SD	4 ± 0.3
Number of BP meds Mean ± SD	2.7 ± 1.3
Cardiac EF %, Median [IQR]	60 [55, 65]
Systolic dysfunction N (%)	44 (18.7%)
Diastolic dysfunction N (%)	142 (78.4%)
Baseline GFR Mean ± SD	46.7 ± 19.6
Number of BP readingsduring follow up Mean ± SD	21 ± 13.6
SBP mmHg Mean ± SD	130.7 ± 12.4
DBP mmHg Mean ± SD	71.3 ± 6.8
Pulse Pressure Mean ± SD	59.4 ± 11.5
Diuretic use N (%)	273 (71.8%)
ACEI use N (%)	176 (46.3%)
ARB use N (%)	70 (18.4%)
Calcium-channel blocker use N (%)	134 (35.2%)
Beta blocker use N (%)	240 (63.1%)
Thiazide diuretic use N (%)	151 (39.7%)
Loop diuretic use N (%)	160 (42.1%)
K sparing diuretic use N (%)	33 (8.6%)
Clonidine use N (%)	15 (3.9%)
Vasodilator use N (%)	59 (15.5%)

IQR: interquartile range; EF: ejection fraction; GFR: glomerular filtration rate (cc/min/BSA); SBP: systolic blood pressure; DBP: diastolic blood pressure.

Table 2. Baseline characteristics of patients with SBP lower and higher than 120 mmHg.

	SBP<120 mmHgN = 68	SBP≥120 mmHgN = 312	pValues
Age, years Mean ± SD	76.9 ± 7.8	75.2 ± 8.8	.12
SBP mmHg, Mean ± SD	113.3 ± 6.3	134.5 ± 9.9	<.0001
DBP mmHg, Mean ± SD	66 ± 4.8	72.5 ± 6.6	<.0001
CHF N (%)	38 (55.9%)	59 (18.9)	<.0001
CVA N (%)	3 (4.4%)	28 (9%)	.32
Cancer N (%)	18 (26.5%)	78 (25%)	.8
Diabetes Mellitus N (%)	31 (45.6%)	162 (51.9%)	.34
HTN N (%)	63 (92.6%)	294 (94.2%)	.62
CAD N (%)	31 (45.6%)	92 (29.5%)	.01
PVD N (%)	17 (25%)	79 (25.3%)	.95
Diastolic dysfunction N (%)	29 (80.5%)	113 (77.9%)	.82
Systolic dysfunction N (%)	15 (32.6%)	29 (15.3%)	.01
EF %, Mean ± SD	53.9 ± 13.2	59 ± 10.4	.01
Atrial Fibrillation N (%)	31 (45.6%)	64 (20.5%)	<.0001
Albumin g/dL, Mean ± SD	3.9 ± 0.44	4 ± 0.34	.09
Hemoglogin g/dL,Mean ± SD	11.8 ± 1.83	12.7 ± 1.78	.001
Proteinuria mg/g,Median [IQR]	100 [12.1, 275]	100 [26, 300]	.36
eGFR cc/min/BSA,Mean ± SD	43.5 ± 18.3	47.4 ± 19.8	.12
Number of BP medicationsMean ± SD	2.8 ± 1.43	2.7 ± 1.33	.49

Figure 1. Systolic blood pressure below 120 mmHg and survival.

Table 3. Primary and secondary outcomes.

	SBP<120 mmHgN = 68	SBP≥120 mmHgN = 312	pValues
Change in GFR (cc/min/BSA),Mean ± SD	−6.4 ± 16.6	−5.4 ± 13.2	.62
CVE N (%)	23 (33.8%)	72 (23.1%)	.05
CKD 5 N (%)	7 (10.2%)	19 (6%)	.28
Mortality N (%)	21 (30.9%)	22 (7%)	<.0001

CVE: cardiovascular events; CKD: chronic kidney disease; GFR: glomerular filtration rate.

Table 4. Cox proportional hazards models for mortality.

	HR (95%CI)	p Values
SBP below 120 mmHg	3.15 (1.57–6.31)	.001
CAD	1.39 (0.71–2.74)	.32
CHF	3 (1.40–6.54)	.004
Atrial Fibrillation	1.42 (0.72–2.85)	.30
SBP below 120 mmHg	3.27 (1.60–6.56)	.001
Albumin	0.45 (0.21–0.98)	.04
Ejection fraction	0.96 (0.91–1.01)	.17
Systolic dysfunction	0.49 (0.10–2)	.33
SBP below 120 mmHg	3.26 (1.60–6.74)	.001
Hemoglobin	0.85 (0.71–1.02)	.08
New cardiovascular event	3 (1.56–6.20)	.001
CHF	2.12 (0.97–4.64)	.057

CAD: coronary artery disease; CHF: congestive heart failure.

Figure 2. (a) Systolic blood pressure below 120 mmHg and survival in patients with CHF. (b) Systolic blood pressure below 120 mmHg and survival in patients without CHF. (c) Systolic blood pressure below 120 mmHg and survival in patients with new cardiovascular events during the follow up period. (d) Systolic blood pressure below 120 mmHg and survival in patients without cardiovascular events during the follow-up period.

Table 5. Cox proportional model for new cardiovascular events.

	HR (95%CI)	p Values
SBP below 120 mmHg	1.10 (0.66–1.80)	.68
CAD	2.12 (1.37–3.28)	.0007
CHF	2.57 (1.64–4.03)	<.0001
PVD	2.20 (1.44–3.32)	.0003

CAD: coronary artery disease; CHF: congestive heart failure; PVD: peripheral vascular disease.