High blood pressure at old age : The Leiden 85 plus study
Bemmel, T. van
Citation
Bemmel, T. van. (2010, February 4). High blood pressure at old age : The Leiden 85 plus
study. Retrieved from https://hdl.handle.net/1887/14652Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
Downloaded from: https://hdl.handle.net/1887/14652
Note: To cite this publication please use the final published version (if applicable).
& +$37(5
6XPPDU\
&KDSWHU
&KDSWHU
7KLVFKDSWHUFRQWDLQVDVKRUWUHYLHZRIWKHKLVWRU\RIKLJKEORRGSUHVVXUH7KH
FKDQJLQJ SHUVSHFWLYH LQ WLPH RI WKH KD]DUGRXV HIIHFW RI KLJK EORRG SUHVVXUH LV
KLJKOLJKWHG,QWKHODVWGHFDGHVWKHUHKDVEHHQDQH[SORVLRQLQNQRZOHGJHDERXW
KLJKEORRGSUHVVXUH$VDUHVXOWRIWKDWWUHDWPHQWJRDOVKDYHEHHQVWULFWHUDQGJRDO
SRSXODWLRQVKDYHEHHQEURDGHU+RZHYHUWKHHYLGHQFHRIDKD]DUGRXVHIIHFWRI
KLJKEORRGSUHVVXUHLQWKHHOGHUO\LVQRWUREXVWDQGHYHQFRQWUDGLFWRU\FRPSDUHG
WRPLGGOHDJHGSHRSOH7RH[SORUHWKLVSRVVLEOHFRQWUDGLFWLRQWKLVWKHVLVKDVWZR
DLPV)LUVWLWFRQWULEXWHVWRREVHUYDWLRQDOHYLGHQFHEHWZHHQKLJKEORRGSUHVVXUHDW
ROGHUDJHDQGDGYHUVHRXWFRPHVLQFOXGLQJFDUGLRYDVFXODUPRUWDOLW\UHQDOIDLOXUH
DQG FRJQLWLYH GHFOLQH 6HFRQGO\ LW WULHV WR GLVHQWDQJOH WKH DVVRFLDWLRQ EHWZHHQ
EORRGSUHVVXUHDQGFDUGLDFIXQFWLRQDWROGHUDJH
&KDSWHU
7KHDLPRIFKDSWHULVWRVWXG\WKHLPSDFWRIDKLVWRU\RIK\SHUWHQVLRQDQGFXUUHQW
EORRGSUHVVXUHRQPRUWDOLW\LQWKHPRVWHOGHUO\7KLVVWXG\ZDVSDUWRIWKH/HLGHQ
SOXV6WXG\DQREVHUYDWLRQDOSRSXODWLRQEDVHGFRKRUWVWXG\LQWKHFRPPXQLW\
FLW\RI/HLGHQWKH1HWKHUODQGV)LYHKXQGUHGDQGQLQHW\QLQHLQKDELWDQWVRIWKH
ELUWKFRKRUWZHUHHQUROOHGRQWKHLUWKELUWKGD\7KHUHZHUHQRVHOHFWLRQ
FULWHULD UHODWHG WR KHDOWK RU GHPRJUDSKLF FKDUDFWHULVWLFV 7KH PHDQ IROORZXS
ZDV \HDUV )LYH KXQGUHG DQG VHYHQW\RQH SDUWLFLSDQWV ZHUH LQFOXGHG
KDG D KLVWRU\ RI K\SHUWHQVLRQ 'XULQJ IROORZXS SDUWLFLSDQWV GLHG
GXH WR FDUGLRYDVFXODU FDXVHV &RPSDUHG WR SDUWLFLSDQWV ZLWKRXW D KLVWRU\ RI
K\SHUWHQVLRQWKRVHZLWKDKLVWRU\RIK\SHUWHQVLRQKDGDLQFUHDVHGPRUWDOLW\
ULVNIURPFDUGLRYDVFXODUFDXVHVEXWHTXDOPRUWDOLW\ULVNVIURPDOOFDXVHV+LJK
EORRGSUHVVXUHDWDJH\HDUVZDVQRWDULVNIDFWRUIRUPRUWDOLW\LUUHVSHFWLYHRI
DKLVWRU\RIK\SHUWHQVLRQ+RZHYHUEORRGSUHVVXUHYDOXHVEHORZPP+J
Q DW DJH \HDUV ZHUH DVVRFLDWHG ZLWK H[FHVV PRUWDOLW\ SUHGRPLQDQWO\ LQ
SDUWLFLSDQWVZLWKDKLVWRU\RIK\SHUWHQVLRQ7KXVLQWKHPRVWHOGHUO\KLJKEORRG
SUHVVXUHLVQRWDULVNIDFWRUIRUPRUWDOLW\LUUHVSHFWLYHRIDKLVWRU\RIK\SHUWHQVLRQ
%ORRGSUHVVXUHYDOXHVEHORZDUHDVVRFLDWHGZLWKH[FHVVPRUWDOLW\
&KDSWHU
&KDSWHU
7KHDLPRIFKDSWHULVWRVWXG\WKHHIIHFWRIEORRGSUHVVXUHRQFUHDWLQLQHFOHDUDQFH
RYHUWLPHLQYHU\ROGSDUWLFLSDQWV+LJKEORRGSUHVVXUHLVDVVRFLDWHGZLWKDGHFOLQH
LQ UHQDO IXQFWLRQ :KHWKHU WKLV LV WUXH IRU YHU\ ROG SHRSOH LV ODUJHO\ XQNQRZQ
7KLVVWXG\ZDVSDUWRIWKH/HLGHQSOXV6WXG\)RUWKLVVWXG\VXEMHFWV
PHQ ZHUH HQUROOHG DW WKHLU WK ELUWKGD\ DQG IROORZHG XQWLO GHDWK RU DJH
%ORRG SUHVVXUH ZDV PHDVXUHG WZLFH DW EDVHOLQH DQG DW DJH \HDUV &UHDWLQLQH
FOHDUDQFHZDVHVWLPDWHGDQQXDOO\&RFNFURIW*DXOWIRUPXOD7KHPHDQFUHDWLQLQH
FOHDUDQFHDWEDVHOLQHZDVPOPLQ6\VWROLFEORRGSUHVVXUHZDVQRWDVVRFLDWHG
ZLWKFKDQJHVLQFUHDWLQLQHFOHDUDQFHGXULQJIROORZXS7KRVHZLWKGLDVWROLFEORRG
SUHVVXUH EHORZ PP+J KDG D VLJQLÀFDQW DFFHOHUDWHG GHFOLQH RI FUHDWLQLQH
FOHDUDQFHFRPSDUHGZLWKWKRVHZLWKKLJKHUGLDVWROLFEORRGSUHVVXUH3DUWLFLSDQWV
ZLWK D GHFOLQH LQ V\VWROLF EORRG SUHVVXUH GXULQJ IROORZXS KDG D VLJQLÀFDQW
DFFHOHUDWHGGHFOLQHRIFUHDWLQLQHFOHDUDQFHFRPSDUHGZLWKWKRVHZLWKVWDEOHEORRG
SUHVVXUHV6LPLODUUHVXOWVZHUHIRXQGIRUDGHFOLQHLQGLDVWROLFEORRG7KXVLQWKLV
VWXG\KLJKEORRGSUHVVXUHDWROGHUDJHLVQRWDVVRFLDWHGZLWKUHQDOIXQFWLRQ,Q
FRQWUDVWORZGLDVWROLFEORRGSUHVVXUHLVDVVRFLDWHGZLWKDQDFFHOHUDWHGGHFOLQHRI
UHQDOIXQFWLRQ
&KDSWHU
7KHDLPRIWKLVFKDSWHULVWRGHWHUPLQHWKHSURVSHFWLYHUHODWLRQVKLSEHWZHHQEORRG
SUHVVXUHDQGFRJQLWLYHIXQFWLRQDFURVVDZLGHDJHUDQJH7KLVVWXG\ZDVSDUWRI
WKH5RWWHUGDP6WXG\DQGWKH/HLGHQSOXV6WXG\ERWKSURVSHFWLYHSRSXODWLRQ
EDVHGFRKRUWVWXGLHV
7KUHH WKRXVDQG VHYHQW\HLJKW PHQ DQG ZRPHQ LQLWLDO DJH WR \HDUV IURP
WKH 5RWWHUGDP 6WXG\ DQG PHQ DQG ZRPHQ LQLWLDO DJH \HDUV IURP WKH
/HLGHQSOXV6WXG\ZHUHLQFOXGHG6\VWROLFEORRGSUHVVXUHDQGGLDVWROLFEORRG
SUHVVXUHZHUHPHDVXUHGDWEDVHOLQHFRJQLWLYHIXQFWLRQZDVDVVHVVHGDWWKHHQG
RIIROORZXSXVLQJDGHGLFDWHGQHXURSV\FKRORJLFDOWHVWEDWWHU\,QWKH\RXQJHVW
SDUWLFLSDQWV\HDUVV\VWROLFDQGGLDVWROLFEORRGSUHVVXUHZHUHQRWDVVRFLDWHG
ZLWK FRJQLWLYH IXQFWLRQ \HDUV ODWHU )RU SHUVRQV DJHG WR \HDUV KLJKHU
EDVHOLQH V\VWROLF DQG GLDVWROLF EORRG SUHVVXUHV ZHUH UHODWHG WR ZRUVH FRJQLWLYH
IXQFWLRQ\HDUVODWHU,QFRQWUDVWLQROGHUDJH\HDUVKLJKHUV\VWROLFDQG
GLDVWROLFEORRGSUHVVXUHVHHPHGWREHUHODWHGWREHWWHUFRJQLWLYHIXQFWLRQDWWKH
HQG RI IROORZXS 7KLV HIIHFW DSSHDUHG VWURQJHVW LQ WKH KLJKHVW DJH JURXS
\HDUV 7KXV KLJK EORRG SUHVVXUH ZDV DVVRFLDWHG ZLWK JUHDWHU ULVN RI FRJQLWLYH
LPSDLUPHQWLQSHUVRQV\RXQJHUWKDQEXWZLWKEHWWHUFRJQLWLYHIXQFWLRQLQROGHU
SHUVRQV
&KDSWHU
7KHDLPRIWKLVVWXG\LVWRHOXFLGDWHWKHXQGHUO\LQJPHFKDQLVPRIWKHREVHUYDWLRQDO
ÀQGLQJV WKDW ORZ EORRG SUHVVXUH LQ WKH YHU\ ROG LV DVVRFLDWHG ZLWK RUJDQ
G\VIXQFWLRQ DQG H[FHVV PRUWDOLW\ :H K\SRWKHVL]HG WKDW FDUGLDF G\VIXQFWLRQ
FRQWULEXWHVWRORZEORRGSUHVVXUHLQWKHYHU\ROG$VDPSOHRISDUWLFLSDQWVDOO
DJHG\HDUVIURPWKH/HLGHQSOXV6WXG\ZHUHLQYLWHG%ORRGSUHVVXUHZDV
PHDVXUHG WZLFH DQG DOO EXW RQH XQGHUZHQW HFKRFDUGLRJUDSK\ WR DVVHVV FDUGLDF
GLPHQVLRQV DQG IXQFWLRQDO FDUGLDF SDUDPHWHUV 6RPH SDUWLFLSDQWV ZHUH IUHH
IURP KHPRG\QDPLFDOO\ VLJQLÀFDQW YDOYXODU GLVHDVH DQG ZHUH LQFOXGHG LQ WKH
SUHVHQWDQDO\VHV7KHUHZHUHORZYDOXHVIRUPHDQFDUGLDFRXWSXWOPLQP DQG PHDQ VWURNH YROXPH POP )RU HYHU\ PP+J GHFUHDVH LQ V\VWROLF
EORRG SUHVVXUH FDUGLDF RXWSXW DQG VWURNH YROXPH ZHUH VLJQLÀFDQWO\ ORZHU
0HDQOHIWYHQWULFXODUHMHFWLRQIUDFWLRQZDVQRUPDODQGKLJKHUIRUHDFKPP+J
GHFUHDVHLQV\VWROLFEORRGSUHVVXUH0HDQOHIWYHQWULFXODUGLPHQVLRQVZHUHQRUPDO
EXWWKH($UDWLRZDVLQGLFDWLQJGLDVWROLFG\VIXQFWLRQ,QFRQFOXVLRQDPRQJ
WKHPRVWHOGHUO\ORZV\VWROLFEORRGSUHVVXUHFRUUHODWHVZLWKORZFDUGLDFRXWSXW
ZKLOHV\VWROLFYHQWULFXODUIXQFWLRQLVQRWLPSDLUHG
&KDSWHU
7KLVVWXG\HYDOXDWHVWKHSUHYDOHQFHRIVLJQLÀFDQWOHIWVLGHGYDOYXODUKHDUWGLVHDVH
LQFRPPXQLW\GZHOOLQJQRQDJHQDULDQV,QDGGLWLRQZHHYDOXDWHGWKHLPSDFWRI
YDOYXODUKHDUWGLVHDVHRQWKHDELOLW\WRSHUIRUPDFWLYLWLHVRIGDLO\OLYLQJ1HVWHG
ZLWKLQ WKH /HLGHQ SOXV 6WXG\ D VDPSOH RI QRQDJHQDULDQV ZDV UHFUXLWHG
7KHOHIWYHQWULFXODU/9GLPHQVLRQVIXQFWLRQDQGWKHSUHVHQFHDQGVHYHULW\RI
KHDUWYDOYXODUGLVHDVHZHUHHYDOXDWHGE\HFKRFDUGLRJUDSK\'DLO\OLIHDFWLYLWLHV
ZHUHDVVHVVHGXVLQJWKH*URQLQJHQ$FWLYLW\5HVWULFWLRQ6FDOH*$56/9FDYLW\
GLDPHWHUV DQG V\VWROLF /9 IXQFWLRQ ZHUH ZLWKLQ QRUPDO IRU WKH PDMRULW\ RI WKH
SDUWLFLSDQWV 6LJQLÀFDQW YDOYXODU GLVHDVH ZDV SUHVHQW LQ LQGLYLGXDOV
ZLWK PLWUDO UHJXUJLWDWLRQ DQG DRUWLF UHJXUJLWDWLRQ EHLQJ PRVWO\ DIIHFWHG
&KDSWHU
DQG UHVSHFWLYHO\ 7KH *$56 VFRUH EHWZHHQ LQGLYLGXDOV ZLWK DQG ZLWKRXW
VLJQLÀFDQWYDOYXODUKHDUWGLVHDVHZDVVLPLODU,QFRQFOXVLRQWKHPDMRULW\RIWKH
QRQDJHQDULDQVIURPWKHJHQHUDOSRSXODWLRQKDYHVLJQLÀFDQWYDOYXODUKHDUWGLVHDVH
WKDWGRHVQRWDIIHFWWKHDELOLW\WRSHUIRUPDFWLYLWLHVRIGDLO\OLYLQJ
&KDSWHU
7KLVVWXG\LQYHVWLJDWHGPDUNHUVRIDXWRQRPLFWRQHRQDVWDQGDUGHOHFWURFDUGLRJUDP
LQUHODWLRQWRPRUWDOLW\LQROGDJH7KLVVWXG\ZDVSDUWRIWKH/HLGHQSOXV6WXG\
$WRWDORILQKDELWDQWVZHUHHQUROOHGLQDSRSXODWLRQEDVHGIROORZXSVWXG\DW
WKHLUWKELUWKGD\(OHFWURFDUGLRJUDPVZHUHWDNHQRQHQWU\DQGDQQXDOO\WKHUHDIWHU
(OHFWURFDUGLRJUDPV ZHUH DQDO\VHG DXWRPDWLFDOO\ WR GHWHUPLQH IRXU PDUNHUV
RI DXWRQRPLF WRQH LH KHDUW UDWH WKH RFFXUUHQFH RI YHQWULFXODU H[WUDV\VWROHV
DQG WZR WLPH GRPDLQ PHDVXUHV RI KHDUW UDWH YDULDELOLW\ $OO SDUWLFLSDQWV ZHUH
IROORZHGXSIRUPRUWDOLW\)RUWKRVHSDUWLFLSDQWVZLWKDKHDUWUDWHLQWKHKLJKHVW
TXDUWLOHWKHWRWDOPRUWDOLW\ULVNZDVIROGLQFUHDVHG+RZHYHUWKH\KDGQRWDQ
LQFUHDVHGFDUGLRYDVFXODUPRUWDOLW\ULVN7KHRFFXUUHQFHRIDWOHDVWRQHYHQWULFXODU
H[WUDV\VWROHZDVUHODWHGZLWKDIROGLQFUHDVHGWRWDOPRUWDOLW\ULVNDQGD
IROGLQFUHDVHGFDUGLRYDVFXODUPRUWDOLW\ULVN,QVWUDWLÀHGDQDO\VHVWKHSURJQRVWLF
HIIHFW ZDV FRQÀQHG WR PDOHV %RWK PHDVXUHV RI KHDUW UDWH YDULDELOLW\ ZHUH QRW
UHODWHG WR PRUWDOLW\ 7KXV RQ D VWDQGDUG VHF (OHFWURFDUGLRJUDP KLJK KHDUW
UDWHDQGWKHRFFXUUHQFHRIDYHQWULFXODUH[WUDV\VWROHERWKPDUNHUVRIV\PSDWKHWLF
GRPLQDQFHZHUHSUHGLFWLYHIRUPRUWDOLW\LQROGDJH7ZRVKRUWWHUPPHDVXUHVRI
KHDUWUDWHYDULDELOLW\DVPHDVXUHGRQDVWDQGDUGVHFHOHFWURFDUGLRJUDPZHUH
QRWUHODWHGWRPRUWDOLW\DQGKHQFHPD\QRWUHÁHFWDXWRQRPLFWRQHLQROGDJH
&KDSWHU
7KLVFKDSWHUUHYHDOVDJHQHUDOGLVFXVVLRQDERXWWKHKD]DUGRXVHIIHFWRIKLJKEORRG
SUHVVXUHLQWKHHOGHUO\7KHSRSXODWLRQEDVHGUHSRUWVLQGLFDWLQJORZHUPRUWDOLW\
DQGPRUELGLW\ULVNVLQDVVRFLDWLRQZLWKKLJKEORRGSUHVVXUHLQWKHYHU\ROGDUH
UREXVWDQGVKRXOGQRWEHLJQRUHG+RZHYHUWKHUHVXOWVRIWKHRQO\UDQGRPLVHG
GRXEOHEOLQGLQWHUYHQWLRQDOWULDOGRQHLVVROLGWRR3RVVLEO\KLJKEORRGSUHVVXUH
FRQFRUGDQW ZLWK D ORZ FDUGLDF RXWSXW LV D GLIIHUHQW HQWLW\ FRPSDUHG ZLWK KLJK
EORRGSUHVVXUHFRQFRUGDQWZLWKDQRUPDOKLJKFDUGLDFRXWSXW7KLVPLJKWH[SODLQ
WKDWHOGHUO\ZLWKDOLPLWHGDPRXQWRIDWKHURVFOHURVLVYDVFXODUGLVHDVHZLOOKDYH
EHQHÀW IURP WUHDWPHQW RI KLJK EORRG SUHVVXUH ,Q FRQWUDVW WKRVH ZLWK D KXJH
DPRXQW RI DWKHURVFOHURVLV YDVFXODU GLVHDVH PLJKW QRW EHQHÀW IURP WUHDWPHQW
GXHWRGHFUHDVHGSHUIXVLRQHVSHFLDOO\LQWKRVHSHUVRQVZLWKDGHFUHDVHGFDUGLDF
RXWSXW &OLQLFLDQV KDYH WR PDNH D GHFLVLRQ ZKHWKHU WKH EORRG SUHVVXUH LQ D
SDUWLFXODUSDWLHQWLVDSSURSULDWHRUQRW2XUK\SRWKHVLVLVWKDWKLJKEORRGSUHVVXUH
FRQFRUGDQWZLWKDORZFDUGLDFRXWSXWVKRXOGQRWEHWUHDWHGLQFRQWUDVWZLWKKLJK
EORRG SUHVVXUH FRQFRUGDQW ZLWK D QRUPDOKLJK FDUGLDF RXWSXW 7KHUHIRUH DW
SUHVHQWZHSURSRVHWKDWWUHDWPHQWRIKLJKEORRGSUHVVXUHLQWKHYHU\ROGLVQRW
ZLWKKHOGEXWKLJKO\LQGLYLGXDOL]HG,QRXURSLQLRQIXWXUHUHVHDUFKVKRXOGIRFXV
RQWKHUHODWLRQEHWZHHQEORRGSUHVVXUHDQGFDUGLDFRXWSXW
&KDSWHU