Blood pressure and disability-free survival among community-dwelling diabetic and non-diabetic elderly patients receiving antihypertensive treatment.

Objective Although many large-scale trials showed efficacies of antihypertensive treatment in patients with diabetes mellitus and hypertension for reduction of cardiovascular ( CV) morbidity/mortality, blood pressure ( BP) targets in older hypertensive patients with diabetes still represent the object of debate. We investigated adequate BP targets with respect to the risk of incident disability or mortality in community-dwelling elderly hypertensive patients with and without diabetes. Methods We analyzed 139 diabetic and 431 non-diabetic patients receiving antihypertensive treatment aged 65 years or older. The end-point was the composite outcome of first certification for support/care need or mortality. Relationships among each of four classes of systolic BP ( SBP) or diastolic BP ( DBP) and the risk of events were estimated using Cox hazards analysis. Results Over 4 years, diabetic patients showed significantly higher rates of all events including first certification for support/care need or mortality compared with the non-diabetic subjects (29 [20.8%] and 48 [11.1%] cases, unadjusted hazard ratio [ HR] 1.99, 95% confidence interval ( CI) 1.26-3.16, P = 0.003). After adjustment for confounding variables, the risk of events was significantly higher in non-diabetic subjects with SBP <120 mmHg ( HR 3.90, 95% CI 1.32-11.5, P = 0.014) and SBP ≥160 mmHg ( HR 3.42, 95% CI 1.22-9.57, P = 0.019), but only those with SBP ≥160 mmHg ( HR 22.8, 95% CI 4.83-118, P < 0.001) in diabetic patients, compared with non-diabetic control subjects with baseline SBP of 140-159 mmHg. Conclusion These observations showed the critical importance of intensive control of SBP to <160 mmHg for disability-free survival in elderly hypertensive patients with diabetes mellitus. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]