Abstract
Objective
To assess whether low systolic blood pressure (SBP) or diastolic blood pressure (DBP)
due to antihypertensive medications might be related to mortality among nursing home
(NH) residents.
Design
Observational, longitudinal.
Setting
Nursing home.
Participants
Age ≥60 years, receiving antihypertensive medications.
Measurements
Demographic characteristics, mobility status, number of chronic diseases and drugs,
nutritional status, and antihypertensive medications were noted. At the first visit,
we recorded blood pressure (BP) measurements of last 1 year, which were measured regularly
at 2-week intervals and considered their mean values. SBP and DBP thresholds were
analyzed for mortality by ROC analysis. Multivariate Cox regression analyses were
performed to determine factors related to mortality.
Results
The sample included 253 residents with a mean age of 75.7 ± 8.7 years, and 66% were
male. Residents were evaluated at a mean follow-up time of 14.3 ± 5.2 months (median:
15) for short-term mortality and 31.6 ± 14.3 months (median: 40) for long-term mortality.
The prevalence of low SBP (≤110 mm Hg) and low DBP (≤65 mm Hg) was 34.8% and 15.8%,
respectively. In follow-up, the short-term mortality rate was 21.7% (n = 55) and the
long-term mortality rate was 42.2% (n = 107). Low SBP (≤110 mm Hg) was related to
mortality in short- and long-term follow-ups [short-term follow-up: hazard ratio (HR)
3.7, 95% confidence interval (CI) 1.5-8.6, P = .01; long-term follow-up: HR 1.8, 95% CI 1.1-3.0, P = .02], adjusted for age, mobility status, nutritional state, and total number of
diseases and drugs. Low DBP (≤65 mm Hg) was related to mortality in short- and long-term
follow-ups [short-term follow-up: HR 3.0, 95% CI 1.2-7.8, P = .02, long-term follow-up: HR 2.8, 95% CI 1.5-5.2, P = .001], adjusted for age, mobility status, nutritional state, and total number of
diseases and drugs.
Conclusions and Implications
Systolic hypotension was found in more than one-third of the NH residents receiving
antihypertensive treatment. Low SBP and DBP were significant factors associated with
mortality. Particular attention should be paid to prevent low SBP and DBP in NH residents
on antihypertensive treatment.
Keywords
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Article info
Publication history
Published online: April 10, 2021
Footnotes
The authors declare no conflict of interest.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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