Disentangling the varying associations between systolic blood pressure and health outcomes in the very old: An individual patient data meta-analysis

Jonathan M.K. Bogaerts, Rosalinde K.E. Poortvliet, Veerle M.G.T.H. Van Der Klei, Wilco P. Achterberg, Jeanet W. Blom, Ruth Teh, Marama Muru-Lanning, Ngaire Kerse, Anna Rolleston, Carol Jagger, Andrew Kingston, Louise Robinson, Yasumichi Arai, Ryo Shikimoto, Jacobijn Gussekloo

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives:While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardiovascular diseases (CVD), and cognitive and physical fitness on the associations between SBP and health outcomes in the very old.Methods:Five cohorts from the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included in a two-step individual participant data meta-analysis (IPDMA). We pooled hazard ratios (HR) from Cox proportional-hazards models for 5-year mortality and estimates of linear mixed models for change in cognitive and functional decline. Models were stratified by BP-lowering treatment, history of CVD, Mini-Mental State Examination scores, grip strength (GS) and body mass index (BMI).Results:Of all 2480 participants (59.9% females, median 85 years), median baseline SBP was 149 mmHg, 64.3% used BP-lowering drugs and 47.3% had a history of CVD. Overall, higher SBP was associated with lower all-cause mortality (pooled HR 0.91 [95% confidence interval 0.88-0.95] per 10 mmHg). Associations remained irrespective of BP-lowering treatment, history of CVD and BMI, but were absent in octogenarians with above-median MMSE and GS. In pooled cohorts, SBP was not associated with cognitive and functional decline.Conclusion:While in the very old with low cognitive or physical fitness a higher SBP was associated with a lower all-cause mortality, this association was not evident in fit octogenarians. SBP was not consistently associated with cognitive and functional decline.

Original languageEnglish
Pages (from-to)1786-1794
Number of pages9
JournalJournal of hypertension
Issue number9
Publication statusPublished - 2022 Sept 1


  • activities of daily living
  • aged
  • antihypertensive
  • blood pressure
  • body mass index
  • cardiovascular
  • cognition
  • frailty
  • grip strength
  • older adults

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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