Hypertension: cardiovascular implications in a cohort of old old

J Am Geriatr Soc. 1992 Apr;40(4):348-53. doi: 10.1111/j.1532-5415.1992.tb02133.x.


Objective: To examine the prevalence and cardiovascular implications of hypertension in advanced age.

Design: Prospective non-interventional study of a fixed cohort of very elderly subjects.

Participants and setting: The subjects were 488 community-dwelling volunteers. Mean age at entry was 79 years (range 75-85). All subjects were ambulatory, non-demented, and free of terminal illness at baseline. Participants were evaluated at the gerontology department of an urban medical school.

Main outcome measures: Cardiovascular morbid and mortal events that were followed included fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, and death. Prevalence of unrecognized myocardial infarction defined by electrocardiographic changes was also assessed.

Results: When hypertension was defined by history, current use of medications, or measured elevations in blood pressure, 78% of the subjects could be considered hypertensive. Univariate analysis showed an increased incidence of strokes in subjects with measured hypertension (P = 0.04). Subjects with elevated blood pressure (untreated) were more likely to develop clinically unrecognized myocardial infarction (P = 0.017). Multivariate survival analysis showed hypertension to be a modest predictor of overall cardiovascular disease (P = 0.067) but not of all-cause mortality. Left ventricular hypertrophy was a predictor of cardiovascular disease (P = 0.013) and all-cause mortality (P = 0.008). Age remained a significant risk factor for these endpoints, even in the very old. Isolated systolic hypertension was analyzed separately and in univariate analysis was a risk factor for stroke but not other cardiovascular morbidity.

Conclusions: Hypertension at advanced age remains a modestly important risk factor in the development of cardiovascular disease.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over*
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Female
  • Hospitals, University
  • Humans
  • Hypertension / classification
  • Hypertension / complications*
  • Hypertension / epidemiology
  • Incidence
  • Male
  • Medical History Taking
  • New York City / epidemiology
  • Population Surveillance
  • Predictive Value of Tests
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Survival Analysis


  • Antihypertensive Agents