BP Tends to Decrease in the 10 Years Before Death

In patients who die at age 60 years or older, mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels tend to decrease for more than 10 years before death, according to a recent study. This finding could serve future initiatives toward risk estimation and treatment monitoring.

For their study, the researchers evaluated the electronic medical records population-based Clinical Practice Research Datalink primary care and linked hospitalization electronic medical records of 46,634 patients from the United Kingdom (mean age at death: 82.4 years). All participants included in the study had available BP measures over 20 years and had died at age 60 years or older between 2010 and 2014.
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Retrospective approaches with generalized linear mixed-effects modeling were implemented. BP slopes from 3 to 10 years before death were compared for 20,207 participants who died, in addition to 20,207 participants matched by birth year and sex who had survived longer than 9 years.

Findings showed that SBPs and DBPs tended to peak 14 to 18 years before death and subsequently decreased as time passed. Mean changes in SBP from peak values were calculated as -8.5 mm Hg for patients dying between ages 60 and 69 years and -22.0 mm Hg for patients dying at age 90 years or older. The researchers observed that 64.0% of participants had changes in SBP of more than -10 mm Hg.

They also found that reductions in BP had been linear in the last 3 to 10 years before death, and reductions became steeper during the last 2 years of life. Although participants not treated for hypertension showed decreases in SBP during the 3 to 10 years before death, the researchers noted that mean changes in BP per year had been steepest in participants with hypertension (−1.58 mm Hg), dementia (−1.81 mm Hg), heart failure (−1.66 mm Hg), and weight loss during late life.

“Mean SBP and DBP decreased for more than a decade before death in patients dying at 60 years and older,” the researchers concluded. “These BP decreases are not simply attributable to age, treatment of hypertension, or better survival without hypertension. Late-life BP decreases may have implications for risk estimation, treatment monitoring, and trial design.

—Christina Vogt

Reference:

Delgado J, Bowman K, Ble A, et al. Blood pressure trajectories in the 20 years before death. JAMA Intern Med. 2018;178(1):93-99. doi:10.1001/jamainternmed.2017.7023.