Systolic Blood Pressure and Survival to Very Old Age: Results From the Women's Health Initiative

Bernhard Haring, Department of Medicine III, Saarland University, Homburg, Germany (B.H.).
Chris A. Andrews, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.).
Kathleen Hovey, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.).
Aladdin H. Shadyab, Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine (A.H.S.), University of California, San Diego, La Jolla.
Andrea LaCroix, Herbert Wertheim School of Public Health and Human Longevity Science (A.H.S., A.L.), University of California, San Diego, La Jolla.
Lisa Warsinger Martin, Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (L.W.M.).
Milagros C. Rosal, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (M.C.R.).
Lewis H. Kuller, Department of Epidemiology, University of Pittsburgh, PA (L.H.K.).
Elena Salmoirago-Blotcher, Departments of Medicine and Epidemiology, Brown University, Providence, RI (E.S.-B.).
Nazmus Saquib, College of Medicine, Sulaiman AlRajhi University, Saudi Arabia (N.S.).
Patrick Koo, Department of Pulmonary, Critical Care, and Sleep Medicine, Baroness Erlanger Hospital, University of Tennessee College of Medicine Chattanooga (P.K.).
Deepika Laddu, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (D.L.).
Marcia L. Stefanick, Department of Medicine, Stanford University Medical Center, Palo Alto, CA (M.L.S.).
JoAnn E. Manson, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.E.M.).
Sylvia Wassertheil-Smoller, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (B.H., S.W.-S.).
Michael J. LaMonte, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY (C.A.A., K.H., M.J.L.).

Document Type

Journal Article

Publication Date

5-14-2024

Journal

Circulation

Volume

149

Issue

20

DOI

10.1161/CIRCULATIONAHA.123.067302

Keywords

aging; blood pressure; longevity; women

Abstract

BACKGROUND: The relationship between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine which SBP levels in women ≥65 years of age with or without blood pressure medication were associated with the highest probability of surviving to 90 years of age. METHODS: The study population consisted of 16 570 participants enrolled in the Women's Health Initiative who were eligible to survive to 90 years of age by February 28, 2020, without a history of cardiovascular disease, diabetes, or cancer. Blood pressure was measured at baseline (1993 through 1998) and then annually through 2005. The outcome was defined as survival to 90 years of age with follow-up. Absolute probabilities of surviving to 90 years of age were estimated for all combinations of SBP and age using generalized additive logistic regression modeling. The SBP that maximized survival was estimated for each age, and a 95% CI was generated. RESULTS: During a median follow-up of 19.8 years, 9723 of 16 570 women (59%) survived to 90 years of age. Women with an SBP between 110 and 130 mm Hg at attained ages of 65, 70, 75, and 80 years had a 38% (95% CI, 34%-48%), 54% (52%-56%), 66% (64%-67%), or 75% (73%-78%) absolute probability to survive to 90 years of age, respectively. The probability of surviving to 90 years of age was lower for greater SBP levels. Women at the attained age of 80 years with 0%, 20%, 40%, 60%, 80%, or 100% time in therapeutic range (defined as an SBP between 110 and 130 mm Hg) had a 66% (64%-69%), 68% (67%-70%), 71% (69%-72%), 73% (71%-74%), 75% (72%-77%), or 77% (74%-79%) absolute survival probability to 90 years of age. CONCLUSIONS: For women >65 years of age with low cardiovascular disease and other chronic disease risk, an SBP level <130 mm Hg was found to be associated with longevity. These findings reinforce current guidelines targeting an SBP target <130 mm Hg in older women.

Department

Medicine

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