American Journal of Epidemiology Vol. 138, No. 6: 365-379
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health
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Modification of Increasing Systolic Blood Pressure in the Elderly during the 1980s
1Division of Preventive Medicine, Department of Medicine, Bngham and Women's Hospital Boston, MA
2Department of Medicine, Harvard Medical School Boston, MA
3Departments of Ambulatory Care and Prevention, Harvard Medical School Boston, MA.
4East Boston Neighborhood Health Center East Boston, MA.
Reprint requests to Dr. Robert J. Glynn, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215-1204
The authors examined whether changing attitudes and approaches to modifying blood pressure during the 1980s affected the previously described pattern of increasing systolic blood pressure in the elderly which continues through the ninth decade of life. In 1982–1983, a door-to-door census identified 4,497 community-dwelling residents of East Boston, Massachusetts aged 65 and over, of whom 3,657 had baseline blood pressure assessments. Follow-up blood pressure assessments occurred in 1985–1986 and in 1988–1989. Cross-sectionally, the relation of age with systolic blood pressure was quadratic with levels predicted to increase until about age 84 after which they were lower among oldest-old survivors Longitudinally, mean age-sex-adjusted systolic blood pressure was 3 3 mmHg lower in 1985–1986 compared with 1982–1983 (95 percent confidence interval (Cl) 2.4–4.2 mmHg) and 10 6 mmHg lower in 1988–1989 compared with 1982–1983 (95 percent Cl 9.5–11.7 mmHg). Utilization of antihypertension medications increased over time and accounted for some, but not all, of the observed decreases in systolic blood pressure Large shifts occurred in the use of specific antihypertension medications including increases in use of angiotensin converting enzyme inhibitors and calcium entry blockers and decreases in use of thiazide diuretics. Previously described trends for increasing systolic blood pressure in the elderly were reversed during the 1980s when the continued decline in cardiovascular mortality was greatest among the elderly Am J Epidemiol 1993; 138:365–79
aging; blood pressure; hypertension; longitudinal studies
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