This binational cohort study analyzed 219 patients aged 90 and older who were admitted to the ICU following an in-hospital cardiac arrest. While clinical focus often shifts to average or minimum blood pressure, this research specifically investigated the prognostic value of the highest blood pressure (SBP, DBP, and MAP) recorded within the first 24 hours.

The findings revealed a high mortality rate, 58% at 30 days and nearly 66% at one year, and identified specific thresholds where lower “peak” pressures significantly increased the risk of death.

The data indicates that even when looking at the highest recorded values, patients who failed to reach thresholds of SBP 140 mmHg, DBP 74 mmHg, or MAP 98–100 mmHg faced a higher hazard of mortality.

Specifically, every 1 mmHg decrease below these levels was associated with a roughly 2% increase in the hazard of death.

These results suggest that for nonagenarians and centenarians, early hypotension is a powerful independent predictor of poor outcomes, highlighting the need for vigilant hemodynamic monitoring and potentially more aggressive blood pressure management in this ultra-vulnerable population.

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