Resumen
to investigate whether the association between blood pressure and clinical outcomes is different in older adults with and without frailty, using observational studies. Methods: MEDLINE, EMBASE and CINAHL were searched from 1st January 2000 to 13th June 2018. PROSPERO CRD42017081635. We included all observational studies reporting clinical outcomes in older adults with an average age over 65 years living in the community with and without treatment that measured blood pressure and frailty using validated methods. Two independent reviewers evaluated study quality and risk of bias using the ROBANS tool. We used generic inverse variance modelling to pool risks of all-cause mortality adjusted for age and sex. Results: nine observational studies involving 21,906 older adults were included, comparing all-cause mortality over a mean of six years. Fixed effects meta-analysis of six studies demonstrated that in people with frailty, there was no mortality difference associated with systolic blood pressure <140 mm Hg compared to systolic blood pressure >140 mm Hg (HR 1.02, 95% CI 0.90 to 1.16). In the absence of frailty, systolic blood pressure <140 mm Hg was associated with lower risk of death compared to systolic blood pressure >140 mm Hg (HR 0.86, 95% CI 0.77 to 0.96). Conclusions: evidence from observational studies demonstrates no mortality difference for older people with frailty whose systolic blood pressure is <140 mm Hg, compared to those with a systolic blood pressure >140 mm Hg. Current evidence fails to capture the complexities of blood pressure measurement, and the association with non-fatal outcomes.
| Idioma original | English |
|---|---|
| Páginas (desde-hasta) | 627-635 |
| Número de páginas | 9 |
| Publicación | Age and Ageing |
| Volumen | 48 |
| N.º | 5 |
| DOI | |
| Estado | Published - sep. 1 2019 |
Nota bibliográfica
Funding Information:Declaration of Conflict of Interest: Kenneth Rockwood is President and Chief Science Officer of DGI Clinical, which has contracts with pharma on individualised outcome measurement. In 2017 he attended an advisory board meeting with Lundbeck. Otherwise all personal fees are for invited guest lectures and academic symposia. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, with additional funding from the Alzheimer Society of Canada and several other charities, as well as from Pfizer Canada and Sanofi Canada. The remaining authors have no support from any organisation (except for funding bodies listed above) for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.
Funding Information:
Declaration of Sources of Funding: This work was supported by: Dunhill Medical Trust, UK [RTF107/0117 to OMT]; Wellcome Trust [206470/Z/17/Z to MHall]; Wellcome Trust/Royal Society Sir Henry Dale Fellowship, UK [211182/Z/18/Z to JS]; and National Institute for Health Research (NIHR), UK [Academic Clinical Fellowship to MHale]; NIHR Oxford Collaborations for Leadership in Applied Research and Care (CLAHRC) to JS & RM; NIHR Yorkshire & Humber CLAHRC [IS-CLA-0113-10020 to AC & JY]. NIHR School for Primary Care Research to JS. The views and opinions expressed are those of the authors and do not necessarily reflect those of the National Health Service, NIHR, or the Department of Health, UK.
Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society.
ASJC Scopus Subject Areas
- Ageing
- Geriatrics and Gerontology