Clinical significance of falling blood pressure among older adults

We assessed the prevalence of falling blood pressure among older adults and its relationship to subsequent outcomes, using public use data from four sites of the Established Populations for Epidemiologic Studies of the Elderly. Seventeen percent of subjects had a decrease in systolic blood pressure of 20 mm Hg or greater and 22% had a decrease in diastolic blood pressure of 10 mm Hg or greater between year 0 and year 3. Falling systolic and diastolic blood pressure was associated with increased all-cause mortality (OR 1.5, 95% CI 1.3, 1.7), cardiovascular mortality (OR 1.6, 95% CI 1.3, 1.9) and all cardiovascular events (OR 1.4, 95% CI 1.2, 1.6) in the subsequent 3 years (years 4 to 6). Increasing amount of fall in blood pressure was associated with increasing risk of mortality. The magnitude of effect of falling blood pressure on adverse outcomes declined and became nonsignificant after adjusting for comorbidity and functional status at baseline. Thus, falling blood pressure is common among older adults and is a marker for underlying poor health and subsequent mortality.