Low diastolic blood pressure associated with ischemic colitis in older women, study finds
A history of cardiovascular disease was associated with a significantly higher incidence of ischemic colitis, and after adjustment, diastolic blood pressure below 90 mm Hg and use of two or more types of antihypertensive medication were significant predictors of risk.
The incidence rate of ischemic colitis in older women was twice as high in those with a history of cardiovascular disease than in those without, an analysis of more than 100,000 participants in the Women's Health Initiative found.
Researchers carried out the prospective study to better identify risk, protective factors, and mortality rates for ischemic colitis in older women. A total of 100,825 women ages 65 years or older with an average of 13.1 years of follow-up were included. Findings were published by the American Journal of Gastroenterology on Dec. 9.
Patients with a history of cardiovascular disease had an ischemic colitis incidence rate of 55.7 per 10,000 person-years, compared to 27.3 per 10,000 person-years in women with no such history. After adjustment, diastolic blood pressure below 90 mm Hg (adjusted hazard ratio [aHR], 1.23 [95% CI, 1.09 to 1.39] with 60 mm Hg vs. 89 mm Hg), use of two or more types of antihypertensive medication compared to none (aHR, 1.62; 95% CI, 1.47 to 1.78), and GI symptoms (aHR, 1.31 [95% CI, 1.20 to 1.42] for the highest versus lowest quartile) were all associated with higher ischemic colitis risk. Relative risk of ischemic colitis was also 12% higher with each five-year incremental increase in age (P<0.001).
Higher fiber intake was associated with lower risk of ischemic colitis (aHR, 0.93 [95% CI, 0.89 to 0.97] per increase of 10 g/d). In addition, Black women had a lower adjusted risk than White women (aHR, 0.73; 95% CI, 0.63 to 0.83). After ischemic colitis, the 30-day all-cause mortality rate was 10.6% and was higher among Black women than White women. The proportion of deaths due to sepsis was 12.1% within the first 30 days versus 4.3% over long-term follow-up, suggesting that sepsis poses an important early mortality risk in ischemic colitis, the study authors said.
Limitations include that only fee-for-service Medicare data were included and findings may not be generalizable outside of the population studied.
Overall, “low diastolic blood pressure and being on antihypertensive medications was associated with higher risk [of ischemic colitis], likely reflecting low perfusion, while higher fiber intake was associated with lower risk,” the authors wrote. They concluded that additional research on class and dosage of antihypertensive therapy is warranted.