Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study

Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading tochallenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD)mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included olderadults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Servicehealth checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medicationfor hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during thefollow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mmHg to >= 160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine therelationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 yearsand 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-upperiod, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults withSBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 yearshad higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortalityrates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as theminimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adultsaged 65-74 years