# Baseline and 7-Year longitudinal trajectories of systolic blood pressure and all-cause mortality in the elderly: A large prospective cohort study in China, 2017–2023

## TL;DR

This study finds that moderate increases in systolic blood pressure with age may reduce mortality risk in elderly Chinese individuals.

## Contribution

Identifies age-adjusted systolic blood pressure ranges linked to lower mortality in elderly populations.

## Key findings

- Baseline SBP of 100–139 mmHg was associated with lowest all-cause mortality.
- Class 2 trajectories (normal-high to elevated) showed lowest all-cause mortality risk.
- Class 1 trajectories (ideal to elevated) had lowest cardiovascular mortality.

## Abstract

Hypertension is a critical modifiable risk factor for mortality in the elderly, yet optimal systolic blood pressure (SBP) targets for older adults remain unclear. This study examined the association between SBP trajectories and all-cause mortality in Chinese elderly individuals, aiming to identify age-adjusted SBP ranges for survival benefits.

A population-based prospective cohort study was conducted in Luzhou, China (2017–2023). A total of 390,100 participants aged ≥65 years were followed for 1,994,050 person-years, with 48,013 deaths analyzed. Cox proportional hazards and restricted cubic spline (RCS) Cox regression models were used to evaluate baseline SBP categories, 7-year mean SBP, and longitudinal trajectories (Class 1: ideal to elevated; Class 2: normal-high to elevated; Class 3: mild hypertension to elevated).

Baseline SBP: Lowest mortality risk at 100–139 mmHg (HR < 1). 7-year mean SBP: Optimal range at 120–159 mmHg. Trajectories: Class 2 (normal-high to elevated) had the lowest all-cause mortality (HR: 0.90, 95% CI: 0.88–0.92). Class 1 showed the lowest cardiovascular mortality. Class 3 exhibited the lowest non-cardiovascular/cancer mortality.

Gradual SBP increases from normal (≤160 mmHg) with age are associated with reduced mortality in the elderly. These findings challenge strict hypertension control guidelines, advocating for age-adjusted SBP targets to optimize survival outcomes. Further validation across different ethnic groups and regions will be needed in the future.