Systolic blood pressure decline in very old individuals is explained by deteriorating health

Declining systolic blood pressure (SBP) is common in very old age and is associated with adverse events, such as dementia. Knowledge of factors associated with SBP changes could explain the etiology of this decline in SBP. This study investigated longitudinal changes in socioeconomic factors, medical conditions, drug prescriptions, and assessments and their associations with SBP changes among very old followed individuals. The study was based on data from the Umeå85+/Gerontological Regional Database (GERDA) cohort study, which provided crosssectional and longitudinal data on participants aged 85, 90, and ≥95 years from 2000 to 2015. Follow-up assessments were conducted after 5 years. The main outcome was a change in SBP. Factors associated with SBP changes were assessed using multivariate linear regression models. In the Umeå85+/GERDA study, 454 surviving individuals underwent follow-up assessment after 5 years. Of these, 297 had SBP measured at baseline and follow-up. The mean change±standard deviation in SBP was –12±25mm Hg. SBP decline was associated independently with later investigation year (P= .009), higher baseline SBP (P< .001), baseline antidepressant prescription (P= .011), incident acute myocardial infarction during follow-up (P= .003), new diuretic prescription during follow-up (P= .044), and a decline in the Barthel Activities of Daily Living index at follow-up (P< .001). In conclusion, SBP declines among very old individuals. This decline seems to be associated with initial SBP level, investigation year, and health-related factors. Abbreviations: ACE = angiotensin-converting enzyme, ADL = activities of daily living, AMI = acute myocardial infarction, BMI = body mass index, BP = blood pressure, GDS = Geriatric Depression Scale, GERDA = Gerontological Regional Database, MMSE = Mini-Mental State Examination, SBP = systolic blood pressure, SSRI = selective serotonin reuptake inhibitor.