LAUSR

Objective: It is not established to what extent clinic and ambulatory BP be lowered in subjects 80 yrs or more. Design and method: We performed this study whether clinic and ambulatory BP (ABP) monitoring were associated with future events in subjects 80 yrs or more. Clinic and ABP monitoring were performed in 520 subjects and tested the different cutoff values of clinic systolic BP (CSBP) 140 mmHg and 150 mmHg, and ambulatory daytime SBP 135, 150 mmHg or nighttime SBP 120, 135 mmHg The endpoint was set as combined events defined by fatal and non-fatal cardiovascular and non-cardiovascular events. Results: The mean age was 83.2 ± 3.2 yrs, and 44% were male. In Kaplan-Meyer analysis, clinic SBP <140, 140–150, and >150 mmHg at baseline and 12-month later had similar cardiovascular event rates (log-rank test, p = 0.25 and 0.58 respectively). For ambulatory daytime SBP, daytime SBP <135, 135–150, and >150 mmHg had similar event rates, whereas for ambulatory sleep SBP, sleep SBP >135 mmHg tended to have higher event rate followed by subjects with 120–135 and <120 mmHg. In multivariable analysis adjusting for covariates, sleep SBP 120–135 was significantly associated with higher event rates [Hazard ratio (HR) 2.38, 95%CI, 1.08–5.26, p = 0.03), but was insignificant for the sleep SBP >135 mmHg (HR 1.46, 0.56–3.79, p = 0.44). On the other hand, clinic and awake SBP was not the risk of incident events. Conclusions: In a large cohort sample in subjects 80 yrs or more, only sleep SBP 120–135 mmHg compared to <120 mmHg, but not clinic or ambulatory awake BP was a risk of combined outcomes.