Blood Pressure Trajectories in the 20 Years Before Death

Key Points

Question  Do blood pressures (BPs) decrease in older patients, and if so are decreases related to age, proximity to death, or better survival without hypertension?

Findings  In a 20-year cohort analysis of medical records, systolic and diastolic BPs decreased for 14 to 18 years before death. Decreases were present in patients not treated for hypertension but were steepest in patients with hypertension, dementia, heart failure, and late-life weight loss.

Meaning  Substantial BP decreases toward the end of life may have implications for treatment monitoring, and decreases in BP may also bias risk estimation and complicate trial design.


Importance  There is mixed evidence that blood pressure (BP) stabilizes or decreases in later life. It is also unclear whether BP trajectories reflect advancing age, proximity to end of life, or selective survival of persons free from hypertension.

Objective  To estimate individual patient BP for each of the 20 years before death and identify potential mechanisms that may explain trajectories.

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