Abstract T MP99: What Are the Blood Pressure Levels Associated With the Lowest Stroke Rates in the Elderly? Findings From the Reasons for Geographic and Racial Differences in Stroke (regards) Cohort Study
OBJECTIVES: To identify the blood pressure (BP) level associated with the lowest stroke incidence in elderly persons taking antihypertensive medication in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
METHODS: We categorized 13,948 REGARDS participants with hypertension into 3 age groups: 55-64, 65-74 and ≥75 years old and 5 levels of treated systolic BP (SBP): <120 (reference group), 120-129, 130-139, 140-149, and ≥150 mmHg, and 4 levels of diastolic BP (DBP) levels: <70 (reference group), 70-79, 80-89, and ≥90 mmHg. Participants without a history of stroke were followed for a median of 5.7 years (maximum 8.5 years) for incident stroke (n=425).
RESULTS: For participants at age 55-64 SBP level <120 mmHg and DBP <70 mmHg were associated with the lowest risk of stroke (incidence per 1,000 person-years: 2.4, 95%Cl: 1.4-4.0 and 2.5, 95%Cl: 1.3-4.7, respectively). Higher stroke risk was observed at SBP ≥140 mmHg. For those aged 65-74, stroke incidence was increased at SBP ≥130 mmHg and at lower DBP levels (with the lowest stroke risk for DBP ≥90 mmHg). For participants ≥75 years SBP ≥150 mmHg was associated with the highest risk of stroke (incidence rate: 15.0, 95%Cl: 10.5-21.3) but no increased risk was observed for SBP between 120-149 mmHg. For DBP, stroke incidence was highest for DBP <70 mmHg (adjusted incidence rate: 9.8; 95%Cl: 6.8-14.1), and lowest for DBP ≥90 mmHg (adjusted incidence rate: 6.5; 95%Cl: 2.9-14.5) (see table).
CONCLUSIONS: These results suggest that the lowest risk for stroke for the participants between 55-64 years old are at BP levels <140/70 mmHg, for persons 65-74 we should aim at SBP levels <130 mmHg, and for the oldest patients at SBP <150 with DBP ≥90 mmHg for both groups. For participants aged ≥65 a caution should be kept with the reduction of DBP <90 mmHg, what requires further investigations.
Key words: blood pressure, elderly, hypertension, treatment, mortality, stroke.
Author Disclosures: M. Banach: None. S. Bromfield: None. G. Howard: None. V.J. Howard: None. A. Zanchetti: None. W.S. Aronow: None. A. Ahmed: None. M.M. Safford: None. P.M. Muntner: None.
- © 2014 by American Heart Association, Inc.