Few data exist on blood pressure in the old and very old. As a substantial part of patients (Pts) with symptomatic coronary artery disease (CAD) is older than 80 years, knowledge of age-dependance of blood pressure (BP) in these patients is mandatory to prevent inadvertent consequences.
Between 2002 and 2016, in 6344 patients Pts presenting the first time in our institution with indication for percutaneous coronary intervention (PCI - 3691 Pts with acute myocardial infarction (MI)). BP was measured at the beginning of PCI with the pigtail catheter in the coronary sinus. 10 BP cycles were averaged for determining systolic (RRs), diastolic (RRd), mean (RRm) BP, and BP amplitude (RR-Amp). 69.2% Pts were male, median age was 68 yrs (95% CI 64,7 – 65,4; IQR 58 – 76 yrs). Coronary artery disease was classified as 1-, 2- or 3-vessel disease (VD), if a diameter stenosis > 50% of a major epicardial coronary artery was present in 1, 2 or 3 coronary arteries, respectively. Left main disease was was not additionally categorized. 1-VD was found in 32,5%, 2-VD in 31,3%, and 3-VD in 36,2% of Pts. Arterial hypertension was found in 79,2%, diabetes in 34,5%, dyslipidaemia in 79%, smoking in 27,6%, obesity in 33,4%, family history of cardiovascular disease in 14%, cerebrovascular disease in 7,4%, peripheral arterial occlusive disease in 3,3% Pts. 10,4% had a history of MI, 6,2% CABG, 10,8% prior PCI, and on dialysis were 1,3%.
BP increased from < 40 years to it's peak at 80 years (p < 0,001, ANOVA – Log-Transformation) with a slight decrease thereafter, whereas diastolic BP decreased from age 60 continuously (p < 0,001, ANOVA – Log-Transf.). Consequently RR-Amp as sign of arterial stiffness increased to it's peak at 90 years (p < 0,001, ANOVA – Log-Transf.), whereas RRm showed only a moderate decrease (p < 0,001, ANOVA – Log-Transf.).
In Pts with symptomatic CAD and indication for coronary intervention systolic BP reaches it's peak at 80 years with a decline thereafter, accompanied by a decrease of diastolic BP which starts earlier in life. As a consequence coronary perfusion pressure decreases, as it is mainly driven by diastolic blood pressure. Additionally, decreasing systolic as well as diastolic BP might cause renal or cerebral malperfusion. Careful BP therapy is mandatory in old and very old Pts with symptomatic CAD to maintain or improve quality of life and to prevent symptoms caused by therapeutic interventions.