Hypertension, but Not Cancer or Obesity, Is Compatible With Extreme Longevity

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Here are a couple of very interesting papers, drawn from a huge data set. Some insights about which non-communicable diseases have real impact on your odds of reaching centenarian status. And some insights about heritability and disease.

Hypertension, but Not Cancer or Obesity, Is Compatible With Extreme Longevity: A Multi-Institution Analysis of 733,919 US Centenarians

https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70691

Exceptional Parental Longevity and Onset of Morbidity and Mortality Across Cohorts

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2853297

Initial Paper Summary posted by RapAdmin:

Who Makes It to 100? Plenty of People With High Blood Pressure, Hardly Anyone With Obesity

Stanford researchers searched Epic Cosmos, a network of electronic health records (EHR) from more than 270 US health systems. They found 733,919 patients aged 100 or older, 18.3 million aged 80 to 99, and 10.4 million adults who died between 2016 and 2026. Among the centenarians, hypertension (62.9%) and high cholesterol (41.2%) were common, diabetes sat in the middle (16.1%), and obesity (3.2%) and cancer (0.5%) were rare. When people were grouped by age at death, hypertension stayed high to the end (74.5% at 100+). Cancer, obesity and diabetes rose through middle age and then fell away. The authors argue that conditions usually grouped as “cardiometabolic risk” behave very differently at extreme age. They also admit the records show only what was documented recently, not a lifetime of disease history. The centenarian count itself looks too high next to US Census figures, which raises more doubt about data quality.

More Americans than ever are reaching 100, and researchers have long wanted to know what sets them apart. A Stanford University analysis offers the biggest look yet at their medical records, and the answer is not perfect health.

Fateme Nateghi Haredasht and her colleagues searched Epic Cosmos, a database that pools electronic health records from more than 270 US health systems. They found 733,919 patients aged 100 or older who visited a clinic or hospital between 2016 and mid-2026, plus more than 18 million people in their 80s and 90s. The previous largest US study of centenarian health included about 3000 people, most of them male military veterans.

Among the centenarians, high blood pressure was the rule rather than the exception, recorded in 62.9 percent. Raised cholesterol appeared in 41.2 percent and diabetes in 16.1 percent. Obesity (3.2 percent) and cancer (0.5 percent) were rare.

The team also examined more than 10 million people who died during the study, grouped by age at death. High blood pressure climbed steadily, from 30 percent in people who died before 40 to about 80 percent in those who died in their 80s and 90s, and stayed near 75 percent in those who died after 100. Cancer followed an arch. Lung cancer, for instance, was recorded in 1.9 percent of people who died in their 60s but just 0.04 percent of those who died after 100. Obesity also rose and fell, dropping from 24 percent at its peak to just over 4 percent among the oldest.

The authors’ reading is that some conditions are compatible with reaching 100 and others are not. High blood pressure is common and treatable with cheap, effective drugs, so people can carry the diagnosis for decades. Fast-killing cancers, such as pancreatic cancer, remove people from the pool long before extreme old age.

The paper is frank that its data cannot prove this. Health records capture what was written down recently. A tumor treated at 60 may have vanished from a patient’s chart by 100. People also lose weight in their final years, which can make obesity and even type 2 diabetes disappear from the record. And today’s centenarians, born around 1920, lived most of their adult lives before the obesity epidemic, so their low obesity rates may say as much about their generation as their biology.

There is a further puzzle the authors do not address. The US Census counted about 80,000 centenarians in 2020. Even allowing for a decade of people turning 100 and dying, more than 700,000 in a single database looks too many. That hints that some records carry wrong birth dates or belong to people whose deaths were never logged. If so, some of the rarity of cancer and obesity among centenarians could be an artifact of thin records.

Still, the broad shape of the findings matches smaller, more carefully verified centenarian studies. Reaching 100 does not seem to require escaping every disease of aging, only avoiding, delaying or controlling the ones that kill quickly. Treated high blood pressure appears to be one that many people can live with for a very long time.

Actionable Insights

These figures come from medical records, not a trial, so none of them is a proven benefit of changing your habits.

  1. Weight and blood sugar show the clearest signal. Among people who died at 100 or older, documented obesity was 82% less common than at its midlife peak (4.3% versus 24.1%, about 1 in 23 people versus 1 in 4). Diabetes was 61% less common (11.4% versus 29.6%, about 1 in 9 versus 3 in 10). Generational change and weight loss before death explain part of these gaps, so treat them as upper limits.
  2. A high blood pressure diagnosis does not rule out reaching 100. Of those who died at 100 or older, 74.5% had one, only 7% fewer than at the peak. That is not a reason to ignore it; the likely explanation is that treatment works. In the HYVET trial of adults aged 80 and over, blood pressure drugs cut deaths from any cause by 21% in under two years. That works out to about one death prevented for every 40 to 45 people treated.
  3. Cancer-free charts at 100 mostly reflect who survived and what got written down. Many centenarians survived earlier cancers, so age-appropriate screening still makes sense.

Context and Source

  • Full title: Hypertension, but Not Cancer or Obesity, Is Compatible With Extreme Longevity: A Multi-Institution Analysis of 733,919 US Centenarians
  • Authors: Fateme Nateghi Haredasht, Kameron C. Black, Chukwuebuka Anyaegbuna, Stephen P. Ma, Vyjeyanthi S. Periyakoil, Jonathan H. Chen
  • Institution: Stanford University (Division of Computational Medicine; Department of Medicine; Division of Hospital Medicine; Division of Primary Care and Population Health; Clinical Excellence Research Center)
  • Country: United States
  • Journal: Journal of the American Geriatrics Society (JAGS), 2026
  • Impact evaluation: The impact score of this journal is 4.6 (Clarivate Journal Impact Factor, most recent listing; prior year 4.5; Scopus CiteScore about 8.8), evaluated against a typical high-end range of 0-60+ for top general science and clinical medicine journals, therefore this is a Medium impact journal.
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For decades, modern preventative medicine operated on an uncompromising doctrine: cardiometabolic diseases are an indivisible cluster of silent killers that must be aggressively suppressed to preserve human lifespan. The historical quest to understand extreme longevity initially unfolded through small, localized demographic cohorts. In the late twentieth and early twenty-first centuries, seminal efforts like the New England Centenarian Study categorized exceptional agers into survivors who acquired chronic diseases before age eighty, delayers who postponed morbidity until their late eighties or nineties, and escapers who reached one hundred without major diagnosis [1]. Yet, because these foundational cohorts were constrained to a few hundred or a few thousand participants, epidemiological consensus entrenched a singular assumption: reaching one hundred years of age demanded widespread biological evasion across all cardiometabolic fronts. Subsequent veteran analyses expanded observations to approximately three thousand centenarians, hinting that chronic illness patterns were nuanced, but the true population-wide trajectory of aging pathologies remained obscured by limited sample sizes [1, 2].

A landmark multicenter real-world investigation from Stanford University published in the Journal of the American Geriatrics Society has upended this monolithic paradigm [1]. Analyzing the Cosmos electronic health record database spanning more than 270 US healthcare systems and 250 million individuals, the investigators examined 733,919 centenarians aged one hundred or older alongside 18,301,566 older adults aged 80 to 99, while tracking diagnostic endpoints across 10,411,646 decedents [1]. The findings unveil a profound divergence in disease compatibility: the conditions classically grouped under cardiometabolic syndrome split along distinct survival vectors, demonstrating that extreme human longevity can coexist with hypertension and hyperlipidemia, while showing profound intolerance toward obesity and cancer [1].

Geographically and socioeconomically, centenarians demonstrated distinct baseline enrichment compared with the 80 to 99 comparison group, clustering more frequently in metropolitan centers (83.5% versus 79.9%) and within the least socioeconomically deprived Area Deprivation Index quintile (12.1% versus 10.9%) [1]. Within the living centenarian cohort, documented diagnoses shattered traditional clinical expectations: hypertension stood at a striking 62.9%, hyperlipidemia remained robust at 41.2%, and type 2 diabetes mellitus settled at an intermediate 16.1% [1]. In stark contrast, obesity was recorded in only 3.2% of centenarians, and active cancer diagnoses plunged to an astonishingly low 0.5% [1].

The divergence becomes even sharper when mapping diagnostic prevalence against final age at death across 10,411,646 deceased individuals [1]. All six major neoplastic malignancies—lung, breast, colorectal, pancreas, prostate, and melanoma—exhibited a pronounced inverted-U trajectory [1]. Cancer prevalence peaked during the sixth and seventh decades of life (ages 60 to 69) before plummeting toward near-zero levels in centenarian decedents [1]. For instance, lung cancer prevalence collapsed from 1.9% at its midlife apex to 0.04% among those dying at or beyond one hundred years of age [1].

Cardiometabolic conditions, conversely, followed entirely bifurcated survival paths [1]. Rather than diminishing, vascular stiffness and hypertensive phenotypes proved remarkably sustainable [1]. Documented hypertension rose continuously from 30.3% in young adulthood (ages 18 to 39) to approximately 80% among octogenarians and nonagenarians, maintaining an overwhelming 74.5% prevalence among individuals dying at 100 years or older [1]. Hyperlipidemia mirrored this durability, climbing to a peak of 70.2% between ages 80 and 89 before sustaining a 50.2% prevalence at extreme terminal age [1]. In sharp opposition, metabolic adiposity and glycemic failure peaked in midlife and underwent steep attrition toward terminal life stages: obesity receded from a 24.1% peak down to 4.3%, while diabetes dropped from 29.6% down to 11.4% [1].

Analyzing these clinical surrogate markers and diagnostic endpoints unveils a profound physiological insight that revises our traditional understanding of aging. The systemic durability of hypertension suggests that late-life arterial remodeling and elevated systemic vascular resistance represent a non-lethal, compensatory hemodynamic adaptation to maintain end-organ perfusion through stiffened microvasculature. Because modern pharmacological intervention reliably controls elevated blood pressure without removing the diagnostic code, managed hypertension functions as a survivable chronic trait rather than a lethal barrier. Meanwhile, advanced oncogenesis and profound metabolic adiposity act as strict biological filters: individuals carrying heavy oncogenic mutational burdens or chronic systemic lipotoxicity suffer terminal selective attrition long before reaching century status. Furthermore, the precipitous drop in diabetes and obesity at the far end of the lifespan indicates late-life physiological shifts, where involuntary catabolism and age-related weight loss alter measured adiposity and induce glycemic remission in those who survive [1].

Despite the unprecedented cohort size, clinical translation faces critical boundaries. The dataset relies on modern electronic health record documentation within encounter-based systems, omitting asymptomatic centenarians who rarely interact with hospitals and lacking longitudinal onset dates [1]. Diagnoses managed decades prior might be dropped from active problem lists, and historical autopsy studies have documented that fatal neoplasms in the oldest-old often go clinically undetected prior to death [1, 3]. Moreover, functional status, cognitive preservation, and pharmacotherapy exposure were unmeasured, precluding definitive stratification between disease delayers and genuine genetic escapers [1].

Nevertheless, this multi-institution evidence compels a fundamental update of longevity science. Extreme survival is not an immaculate state of total disease avoidance, but a targeted resilience that accommodates vascular and lipid alterations while rigorously filtering out aggressive malignancy and metabolic obesity [1].

[1] Nateghi Haredasht F, Black KC, Anyaegbuna C, Ma SP, Periyakoil VS, Chen JH. Hypertension, but Not Cancer or Obesity, Is Compatible With Extreme Longevity: A Multi-Institution Analysis of 733,919 US Centenarians. Journal of the American Geriatrics Society, 2026. https://doi.org/10.1111/jgs.70691
[2] Kheirbek RE, Fokar A, Shara N, et al. Characteristics and Incidence of Chronic Illness in Community-Dwelling Predominantly Male U.S. Veteran Centenarians. Journal of the American Geriatrics Society, 2017. https://doi.org/10.1111/jgs.15016
[3] Stanta G, Campagner L, Cavallieri F, Giarelli L. Cancer of the Oldest Old: What We Have Learned From Autopsy Studies. Clinics in Geriatric Medicine, 1997. https://doi.org/10.1016/S0749-0690(18)30147-7