Evidence map›Paper›PMID 38822230›Full record

ArticleBMC geriatrics2024

Disability level's impact on blood pressure-mortality association in older long-term care adults: evidence from a large Chinese cohort study.

Yue Zhong, Chuanteng Feng, Lisha Hou, Ming Yang, Xinjun Zhang, Jinhui Wu, Birong Dong, Peng Jia, Shujuan Yang, Qingyu Dou

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Article in BMC geriatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Yue Zhong *Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Chuanteng Feng *Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China.
Lisha HouNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Ming YangNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Xinjun ZhangNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Jinhui WuNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Birong DongNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Peng JiaSchool of Resource and Environmental Sciences, Wuhan University, Wuhan, China.
Shujuan YangWest China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. rekiny@126.com.
Qingyu DouNational Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China. ddqqking@126.com.

Funding

The National Key R&D Program of China 2023YFC3604701
6 · The paper itself

Abstract

backgroundEvidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability.

methodsThis prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.

resultsThe associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135 and 150 mmHg. In severe disability group, SBP < 150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150 and 170 mmHg. The associations were robust in subgroup analyses in terms of age, gender, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk.

conclusionThe optimal SBP range was found to be higher in older individuals in long-term care with severe disability (150-170mmHg) compared to those with mild to moderate disability (135-150mmHg). This study provides new evidence that antihypertensive treatment should be administered cautiously in severe disability group in long-term care setting. Additionally, assessment of disability using the Barthel index can serve as a valuable tool in customizing the optimal BP management strategy.

trial registrationChinese Clinical Trial Registry (Registration Number: ChiCTR2100049973).

Indexed as

Blood PressureLong-Term CarePersons with DisabilitiesAgedAged, 80 and overChinaCohort StudiesEast Asian PeopleFemaleHumansHypertensionMaleMiddle AgedMortalityProspective StudiesBlood pressureDisabilityLong-term careOlder adults

Identifiers

PMID38822230
PMCPMC11143654

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.