Key result
Tight blood pressure control (<120/<70 mm Hg) was associated with a greater risk of incident cardiovascular events compared to usual control in treated hypertensive adults with (HR 1.88) and without (HR 1.71) apparent treatment-resistant hypertension.
Why the study?
Is low treated blood pressure associated with an increased risk of incident cardiovascular disease in treated hypertensive patients with and without apparent treatment-resistant hypertension?
Observational (n=118,356)
Yes
Is low treated blood pressure associated with an increased risk of incident cardiovascular disease in treated hypertensive patients with and without apparent treatment-resistant hypertension?
Low treated blood pressure (<120/<70 mm Hg) is associated with a higher risk of incident cardiovascular events compared to moderate BP control (120-139/70-89 mm Hg), regardless of the presence of apparent treatment-resistant hypertension.
Low treated BP associated with higher CVD events in treated hypertension; hypothesis-generating and leaves open optimal targets pending randomized trials.
Apparent treatment-resistant hypertension (aTRH) may confound the reported relationship between low blood pressure (BP) and increased cardiovascular disease (CVD) in treated hypertensive patients. Incident CVD was assessed in treated hypertensive patients with and without aTRH (BP ≥140 and/or ≥90 mm Hg on ≥3 medications or <140/<90 mm Hg on ≥4 BP medications) at three BP levels: 1: <120 and/or <70 mm Hg and <140/<90 mm Hg; 2: 120-139/70-89 mm Hg; and 3: ≥140 and/or ≥90 mm Hg. Electronic health data were matched to emergency and hospital claims for incident CVD in 118 356 treated hypertensive patients. In adults with and without aTRH, respectively, CVD was greater in level 1 versus level 2 (multivariable hazard ratio, 1.88 [95% confidence interval [CI], 1.70-2.07]; 1.71 [95% CI, 1.59-1.84]), intermediate in level 1 versus level 3 (hazard ratio, 1.32 [95% CI, 1.21-1.44]; 0.99, [95% CI, 0.92-1.07]), and lowest in level 2 versus level 3 (hazard ratio, 0.70 [95% CI, 0.65-0.76]; 0.58, [95% CI, 0.54-0.62]). Low treated BP was associated with more CVD than less stringent BP control irrespective of aTRH.
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Egan et al. (2016) conducted an observational in Hypertension (n=118,356). Tight blood pressure control (<120 and/or <70 mm Hg) vs. Usual blood pressure control (120-139/70-89 mm Hg) was evaluated on Incident cardiovascular disease (composite of myocardial infarction, unstable angina, stroke, or chronic heart failure) (HR 1.88, 95% CI 1.70-2.07, p=<0.05). Tight blood pressure control (<120/<70 mm Hg) was associated with a greater risk of incident cardiovascular events compared to usual control in treated hypertensive adults with (HR 1.88) and without (HR 1.71) apparent treatment-resistant hypertension.
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