Comparative Analysis Of The Clinical Characteristics And The Prognostic Risk Factors In Different Aged Patients With Primary Hypertension

Objective To analyze the clinical characteristics in different aged patients with primary hypertension in order to detect the relationship between the prognostic risk factors and cardiovascular and cerebrovascular events, also to detect the optimal blood pressure target levels.Methods 1059 old patients (male, 78.94%) aged 60 to 94 with primary hypertension were enrolled in the study. All cases had ever been hospitalized in the Chinese PLA General Hospital from September 1999 to January 2001. The patients were divided into the old patient group and the very old patient group based on the age. Patients aged 60-79 were old patient group, while those aged more than 80 were very old patient group. Patients were also divided into the intensified treatment group, the general treatment group and the control group based on the blood pressure levels. Patients with blood pressure less than 130/80mmHg were intensified treatment group, those with blood pressure between 130/80 mmHg and 150/90mmHg were the general treatment group, those with blood pressure more than 150/90mmHg were the control group. Patients were also divided into low diastolic blood pressure (LDBP) group, moderate diastolic blood pressure (MDBP) group and high diastolic blood pressure (HDBP) group. Patients with diastolic blood pressure less than 70mmHg were low diastolic blood pressure group, those with diastolic blood pressure between 70 mmHg and 90mmHg were moderate diastolic blood pressure group, and those with diastolic blood pressure more than 90mmHg were high diastolic blood pressure group. Serum total cholesterol, triglyceride, apoA-1, apo-B, HDL-c, LDL-c, glucose, uric acid, urea nitrogen, creatinine and ultrasonic cardiogram parameters were examined in all patients. Independent student t test, analysis of variance and multivariate regression analysis were used in the statistic analysis.Results During a total of 5316.1 man years' follow-up, 582 cardiovascular and cerebrovascular events in 410 patients and 151 deaths were observed. The morbidity of cardiovascular and cerebrovascular disease, renal dysfunction and the mortality rate in the very old patient group were higher than those in the old patient group. Patients in the very old patient group also had lower levels of diastolic blood pressure, higher levels of systolic blood pressure and pulse pressure. Multivariate regression analysis showed that cardiovascular and cerebrovascular events were related with the systolic blood pressure, diastolic blood pressure, pulse pressure, hyperlipidemia, high gradation of carsiovascular risk, male gender, periphery artery disease and the number of antihypertensive drugs significantly. The mortality rate, cardiovascular and cerebrovascular mortality rate and cardiovascular and cerebrovascular events rate were all highest in the controlled group of both age groups. The mortality rate and cardiovascular and cerebrovascular events rate were lowest in the intensified treatment group in the old patient group. There was no significant difference in the mortality rate, cardiovascular and cerebrovascular mortality rate and cardiovascular and cerebrovascular events rate between the intensified treatment group and the general treatment group in the very old patient group. In the old patient group, the mortality rate and cardiovascular and cerebrovascular mortality rate were highest in HDBP group and lowest in LDBP group, while the cardiovascular and cerebrovascular events rate were highest in the HDBP group but it was similar between MDBP group and LDBP group. In the very old patient group, the mortality rate, cardiovascular and cerebrovascular events rate and cardiovascular and cerebrovascular mortality rate were higher in the LDBP group than in the MDBP group, while there was no significant difference between the HDBP group and the MDBP group.Conclusions Reasonable antihypertensive therapy can benefit elderly patients with primary hypertension in different aged patient groups. All old patients should keep the blood pressure under 150/90mmHg. It could be better for old patients with primary hypertension to keep the blood pressure under 130/80mmHg, but it was uncertain for patients over 80 years old. Increased mortality rate, cardiovascular and cerebrovascular events and cardiovascular and cerebrovascular mortality rate were related independently to diastolic blood pressure less than 70mmHg in the very old patients with primary hypertension.