Modification effect of disability profiles on the association of blood pressure and mortality among older long-term care people

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Yue Zhong,1, Chuanteng Feng, 2, 3,Lisha Hou, 4, Ming Yang, 4, Xinjun Zhang, 4, Jinhui Wu, 4, Birong Dong, 4, Peng Jia, 5,6, Shujuan Yang, 3,6, Qingyu Dou
1 Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China 2 Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China 3 West China School of Public Healt
Cardiovascular

Abstract

Introduction: Evidence of the optimal blood pressure target for older people with disability in long-term care is limited. We aim to estimate the associations of blood pressure with all-cause and cause-specific mortality in older people with different profiles of disability.

Methods: This prospective cohort study was based on the government-led long-term care program in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.

Results: The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135-150 mmHg. In severe disability group, SBP <150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150-170 mmHg. The associations were robust in subgroup analyses in terms of age, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk.

Conclusion: The optimal blood pressure range was higher in older long-term care people with severe disability than those with mild-moderate disability. This study provides new evidence for optimal individualized management of blood pressure in disabled older people in long-term care settings.