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

Zhuo Wang; Yujin He; Tianyong Wu; Zifang Zhou; Zhi Lei; Rujun Liao; Fangyi Yu; Pengyuan Yang; Xiaoyan Wang; Ling Liu; Longling Yang; Qing Yang; Xuefeng Tang; Xianping Wu; Bo Zhong; Hang Chen; Peng Yin; Zhuo Wang; Yujin He; Tianyong Wu; Zifang Zhou; Zhi Lei; Rujun Liao; Fangyi Yu; Pengyuan Yang; Xiaoyan Wang; Ling Liu; Longling Yang; Qing Yang; Xuefeng Tang; Xianping Wu; Bo Zhong; Hang Chen; Peng Yin

doi:10.3934/publichealth.2025043

AIMS Public Health

2025, Volume 12, Issue 3: 857-874. doi: 10.3934/publichealth.2025043

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Research article Special Issues

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

1.
Department of Chronic and Non-communicable Disease Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, China
2.
Department of Chronic and Non-communicable Disease Control and Prevention, Luzhou Center for Disease Control and Prevention, Luzhou, China
3.
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
4.
School of Public Health, North Sichuan Medical College, Nanchong, China
These three authors contributed equally.

Received: 23 June 2025 Revised: 18 August 2025 Accepted: 20 August 2025 Published: 29 August 2025

Background
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.
Methods
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).
Results
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.
Conclusions
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.
- systolic blood pressure,
- elderly,
- mortality,
- Chinese,
- prospective cohort
Citation: Zhuo Wang, Yujin He, Tianyong Wu, Zifang Zhou, Zhi Lei, Rujun Liao, Fangyi Yu, Pengyuan Yang, Xiaoyan Wang, Ling Liu, Longling Yang, Qing Yang, Xuefeng Tang, Xianping Wu, Bo Zhong, Hang Chen, Peng Yin. 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[J]. AIMS Public Health, 2025, 12(3): 857-874. doi: 10.3934/publichealth.2025043

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Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Acknowledgments

We are grateful to all the participators in the present study, and to all the investigators for their support and hard work during this cohort.
This research was funded by National Major Science and Technology Project, Research on Innovation and Application Demonstration of Chronic Disease Prevention and Treatment Technology Promotion Mechanism (2024ZD0523905); Sichuan Provincial Primary Health Care Development Center of North Sichuan Medical College, Relationship between Care Model and Cognitive Function of Elderly Groups from the Perspective of Active Aging (SWFZ24-Z-12); National Science and Technology Major Project, Research and Application Demonstration of Promotion Mechanism of Major Chronic Disease Prevention and Treatment Technology (2024ZD0523900); Project of Chinese Preventive Medicine Association on Construction and Application Research of Elderly Health Examination Cohort and Major Chronic Disease-Specific Database (JKCLPJ202501003).

Authors' contributions

Z.W. and P.Y. conceived and designed the study. T.W., Z.L., F.Y., X.W., L.L., L.Y., Q.Y., and H.C. acquired the data. X.T., X.W., and B.Z. provided critical input in study design. Y.H., Z.Z., R.L., and P.Y. performed the data analysis. Z.W. and B.Z. drafted the manuscript. Z.W., B.Z., H.C., Y.H., and T.W. reviewed, revised, and approved the final manuscript. All authors have read and agreed to the published version of the manuscript.

Conflict of interest

All the authors declare no conflict of interest.

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