What question did this study set out to answer?

To examine how real-world systolic blood pressure affects mortality rates among US Veterans with hypertension.

April 10, 2026Open Access

Blood Pressure Control and Mortality Among US Veterans

Key Result

Routine systolic blood pressure of 130 to 139 mm Hg was associated with the lowest mortality among US Veterans.

Key Points

To examine how real-world systolic blood pressure affects mortality rates among US Veterans with hypertension.
Conducted a retrospective cohort study of veterans with hypertension defined by diagnostic codes and BP readings.
Categorized systolic BP into seven groups for analysis.
Used discrete-time survival models to assess associations with all-cause mortality while adjusting for demographics and comorbidities.
Veterans with systolic BP of 130 to 139 mm Hg had the lowest mortality risk.
Adjusted hazard ratios were 1.29 for BP <110 and 0.83 for BP 130 to 139, compared to BP ≥160 mm Hg.
Associations remained consistent across strata of cardiovascular disease and chronic kidney disease.

Structured PICO

Does routine systolic blood pressure of 130-139 mm Hg reduce all-cause mortality compared to other blood pressure ranges in US Veterans with hypertension?

Population

>2.3 million US Veterans with hypertension (defined by diagnostic codes, antihypertensive prescriptions, or ≥2 office BP readings ≥130/90 mm Hg in 2016 to 2017), mean age 66 years, 36% with diabetes, 22% with cardiovascular disease, and 19% with chronic kidney disease.

Intervention

Routine systolic blood pressure levels categorized into groups (<110, 110-119, 120-129, 130-139, 140-149, 150-159 mm Hg) treated as a time-dependent covariate.

Comparator

Routine systolic blood pressure ≥160 mm Hg.

Outcome

All-cause mortality.hard clinical

In a large real-world cohort of US Veterans with hypertension, a routine systolic blood pressure of 130-139 mm Hg was associated with the lowest all-cause mortality, suggesting that higher BP targets may be appropriate in clinical practice.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Intensive blood pressure (BP) control reduces mortality and cardiovascular disease in clinical trials. However, real-world BP measurements often differ from standardized protocols. We evaluated the impact of real-world systolic BP on mortality among US Veterans. Methods: We conducted a retrospective cohort study of Veterans with hypertension, defined by diagnostic codes, antihypertensive prescriptions, or ≥2 office BP readings ≥130/90 mm Hg in 2016 to 2017, with follow-up through March 2021. Systolic BP was treated as a time-dependent covariate and categorized into 7 groups: 2.3 million Veterans (mean age, 66 years; 36% with diabetes; 22% with cardiovascular disease; and 19% with chronic kidney disease), the lowest mortality risk was observed in those with systolic BP of 130 to 139 mm Hg. In this cohort, adjusted hazard ratios for all-cause mortality per year in each systolic BP category were 1.29 for BP <110; 1.03 for BP 110 to 119; 0.88 for BP 120 to 129; 0.83 for BP 130 to 139; 0.86 for BP 140 to 149; and 0.89 for BP 150 to 159 mm Hg, compared with a year with BP ≥160 mm Hg. These associations remained consistent across cardiovascular disease and chronic kidney disease subgroups. Conclusions: Veterans with routine systolic BP of 130 to 139 mm Hg had the lowest mortality. These findings suggest that a higher BP target may be appropriate in clinical practice, especially for older adults with comorbidities.