Streit S, et al. - Researchers investigated if systolic blood pressure is related to all-cause mortality and altered cognitive function for patients prescribed antihypertensive treatment vs those not. In the oldest-old taking antihypertensives, lower systolic blood pressure was found to be related to higher mortality and faster decline in cognitive function.

Methods

• Researchers studied participants in the population-based Leiden 85-plus cohort study.
• The predictors were baseline systolic blood pressure and use of antihypertensive treatment.
• The outcomes included all-cause mortality and change in cognitive function measured using the Mini-Mental State Examination.
• Grip strength was used as a proxy for physical frailty.
• The link between systolic blood pressure and both time to death and change in cognitive function were assessed using Cox proportional hazards and mixed-effects linear regression models.
• Sensitivity analyses were also carried out, excluding deaths within 1 year and analyses were restricted to participants without a history of cardiovascular disease.

Results

• A total of 570 participants were included; antihypertensive therapy was prescribed to 249 (44%) of them.
• Higher all-cause mortality was observed in participants with lower blood pressure prescribed antihypertensive treatment (HR 1.29 per 10 mmHg lower systolic blood pressure, 95% CI 1.15–1.46, P < 0.001).
• A link between faster cognitive decline and lower blood pressure was seen among participants taking antihypertensives (annual mean change -0.35 points per 10 mmHg lower systolic blood pressure, 95% CI -0.60, -0.11, P=0.004); those with lower hand grip strength exhibited a more rapid decline in cognition.
• No significant links were observed between blood pressure and either mortality or cognitive decline among participants not prescribed antihypertensive treatment.