Ps-c24-2: systolic blood pressure and mortality in elderly patients with heart failure

Background: Optimal blood pressure levels in elderly patients are controversial. Our previous results demonstrated that systolic blood pressure (SBP) lowering to less than 140 mmHg might not improve the prognosis in elderly hypertensive patients with frailty. Optimal blood pressure levels for elderly patients with heart failure (HF) have not yet been established. Objective: To examine the association between SBP level and mortality in elderly outpatients with or without HF. Design and setting and participants: A prospective cohort study of older patients in an outpatient setting in Okinawa (Nambu Cohort Study) included 630 patients. Data were collected from 2017 to 2021. Patients were stratified into four categories according to SBP levels of more or less than 140mmHg and presence or absence of HF. Results: A total of 630 patients, with a median (IQR) age of 78 (71 - 84) years and 50% of whom were men, were followed for a median duration of 42 (34 - 43) months. 56% of them had SBP less than 140 mmHg, and 21% were diagnosed as HF. All-cause mortality occurred in 39 (11%) and 31 (11%) of patients with SBP less than 140 mmHg vs. SBP more than 140 mmHg, respectively (HR 1.02, 95%CI 0.64 - 1.65). Likewise, 32 (24%) and 38 (8%) of patients with HF vs. without HF were dead, respectively (HR 3.75, 95% CI 2.33 - 6.00). Adjusted HR (95%CI) for all-cause death of each category patients was as follows; SBP less than 140 mmHg / Non-HF (Reference), SBP more than 140mmHg / Non-HF 1.41 (0.74 - 2.71), SBP less than 140 mmHg / HF 2.71 (1.40 - 5.29), SBP more than 140mmHg / HF 3.75 (1.67 - 8.09) (Figure). Conclusion: In an elderly outpatient setting, an SBP level of more than 140mmHg was likely associated with an increased risk of all-cause mortality in HF and non-HF patients but not statistically significant. On the other hand, HF was associated with increased mortality risk.