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Abstract：
BACKGROUND: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level.
OBJECTIVE: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension.
METHODS: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older).
RESULTS: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older.
CONCLUSIONS: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years.
OBJECTIVE: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension.
METHODS: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older).
RESULTS: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older.
CONCLUSIONS: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years.
摘要：
背景：患有高血压的老年人的目标收缩压（SBP）水平因国家而异，导致在确定适当的SBP水平方面面临挑战。
目的：本研究旨在确定最佳SBP水平，以最大程度降低韩国老年高血压患者的全因和心血管疾病（CVD）死亡率。
方法：这项回顾性队列研究使用了来自国家健康保险服务数据库的数据。我们纳入了65岁或以上的老年人，他们新诊断出患有高血压，并在2003-2004年接受了国家健康保险服务的健康检查。我们排除了有高血压或CVD病史的患者，没有开高血压药，失去血压或任何其他协变量值，在2020年之前的随访期间，进行了不到2次的健康检查。我们将平均SBP水平分为6类，以10mmHg为增量，从<120mmHg到≥160mmHg；130-139mmHg为参考范围。Cox比例风险模型用于检查SBP与全因死亡率和CVD死亡率之间的关系。亚组分析按年龄组(65~74岁和75岁或以上)进行.
结果：本研究纳入了68,901名新诊断为高血压的老年人。在后续期间,32,588（47.3％）参与者有全因死亡率，4273（6.2％）有CVD死亡率。与SBP在130-139mmHg范围内的老年人相比，属于其他SBP类别的个人，不包括SBP120-129mmHg，显示全因死亡率和CVD死亡率显著较高。亚组分析显示，根据SBP类别，65-74岁的老年人的全因死亡率和CVD死亡率高于75岁或以上的老年人。
结论：120-139mmHg范围内的SBP水平与韩国老年高血压患者的全因死亡率和CVD死亡率最低相关。建议将SBP降低到<140mmHg，以120mmHg作为SBP的最小值，适用于患有高血压的韩国老年人。此外,对于65-74岁的成年人，需要更严格的SBP管理。
目的：本研究旨在确定最佳SBP水平，以最大程度降低韩国老年高血压患者的全因和心血管疾病（CVD）死亡率。
方法：这项回顾性队列研究使用了来自国家健康保险服务数据库的数据。我们纳入了65岁或以上的老年人，他们新诊断出患有高血压，并在2003-2004年接受了国家健康保险服务的健康检查。我们排除了有高血压或CVD病史的患者，没有开高血压药，失去血压或任何其他协变量值，在2020年之前的随访期间，进行了不到2次的健康检查。我们将平均SBP水平分为6类，以10mmHg为增量，从<120mmHg到≥160mmHg；130-139mmHg为参考范围。Cox比例风险模型用于检查SBP与全因死亡率和CVD死亡率之间的关系。亚组分析按年龄组(65~74岁和75岁或以上)进行.
结果：本研究纳入了68,901名新诊断为高血压的老年人。在后续期间,32,588（47.3％）参与者有全因死亡率，4273（6.2％）有CVD死亡率。与SBP在130-139mmHg范围内的老年人相比，属于其他SBP类别的个人，不包括SBP120-129mmHg，显示全因死亡率和CVD死亡率显著较高。亚组分析显示，根据SBP类别，65-74岁的老年人的全因死亡率和CVD死亡率高于75岁或以上的老年人。
结论：120-139mmHg范围内的SBP水平与韩国老年高血压患者的全因死亡率和CVD死亡率最低相关。建议将SBP降低到<140mmHg，以120mmHg作为SBP的最小值，适用于患有高血压的韩国老年人。此外,对于65-74岁的成年人，需要更严格的SBP管理。
