Systolic and diastolic blood pressure (BP) decrease in patients aged 60 and older 14 to 18 years prior to death, according to findings published in JAMA.
João Delgado, PhD, of the Institute of Biomedical and Clinical Science at the University of Exeter Medical School in the UK, and associates conducted a 20-year, large-scale analysis to determine the trajectory of systolic and diastolic BP for patients older than 60 years.
The authors selected 46,634 patients between ages 60 and 111 for the 20-year BP measurements and found that at any point before death, hypertension and heart failure were diagnosed in 55.2% and 7.7% of patients aged 60 to 69 (at time of death), respectively. In the eldest patient group (ages 90 and older at time of death), hypertension and heart failure were diagnosed in 67.2% and 18.6%, respectively.
A positive correlation was observed between increased age at death and increased systolic BP (SBP). Patients aged 60 to 69 had a mean SBP of 139.5 mm Hg, while patients aged 90 years and older had a mean SBP of 150.0 mm Hg. The researchers noted that these mean SBP peaks were found in patients 14 to 18 years before death, and the decline after these peaks was -8.5 mm Hg in patients dying between ages 60 and 69, and -22.0 mm Hg in patients dying at ages 90 and older.
SBP changes greater than -10 mm Hg were seen in 64% of patients with the steepest changes in the final 2 years of life. Mean yearly changes were most profound in patients with hypertension, dementia, heart failure, and late-life weight loss.
The authors concluded that both systolic and diastolic pressures progressively decrease for approximately 10 years prior to death in patients dying at ages 60 years or older.
“More work is needed to elucidate the specific mechanisms involved in late-life BP dynamics,” the investigators wrote. “These findings may also have implications for treatment monitoring in later life.”
- Delgado J, Bowman K, Ble A, et al. Blood pressure trajectories in the 20 years before death. JAMA Intern Med. Published online December 04, 2017. doi:10.1001/jamainternmed.2017.7023