Control of Late-life Systolic Blood Pressure and All-cause Mortality Among Oldest-old People in China: The Chinese Longitudinal Healthy Longevity Survey

Abstract Background: Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between late-life systolic blood pressure control (mean SBP) and variability (SBPV) and mortality in oldest-old people.Methods: Based on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 5951 participants ≥80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was 3-year all-cause mortality assessed between the second and third waves.Results: During 21733.9 person-years of follow-up, 4290 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 2.3 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.16 (comparing lowest versus middle quintile; 95% CI: 1.06, 1.28) with large falls in SBPV and 1.10 (comparing highest versus middle quintile; 95% CI: 1.00, 1.21) with large rises in SBPV.Conclusions: U-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range decreases the risk of mortality in the oldest-old people.