Association of hypotension with mortality among US adults: prospective cohort study

Background The associations of hypotension with mortality in general population remains incompletely understood. We aimed to investigate whether hypotension is associated with higher all-cause and cardiovascular disease (CVD) mortality in this population. Methods In this prospective analysis, we utilized data from the National Health and Nutrition Examination Survey (NHANES, 1999-2018), with mortality information linked until 2019. We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for the associations of different blood pressure (BP) with all-cause and CVD mortality. Findings Among the 37,832 participants, a total of 5261 deaths and 1664 deaths attributed to CVD causes were recorded over a median of 8.4 years of follow-up. The prevalence of hypotension was 7.6%. Both systolic BP and diastolic BP exhibited a J-shaped association with the all-cause and CVD mortality in restricted cubic spline modeling analysis (nonlinear-P <0.01). Compared to the normal BP group, the adjusted HRs for all-cause and CVD mortality in the hypotension group were 1.44 (1.20-1.74) and 1.57 (1.10-2.24), respectively. Subgroup analyses revealed that older individuals (age ≥60 years) and those with obesity exhibited more pronounced HRs for all-cause mortality, with HRs of 1.60 (1.28-2.00) and 1.95 (1.45-2.61), respectively (P for interaction <0.05). Interpretation In this nationally representative cohort of US adults, hypotension demonstrated a significant association with both all-cause and cardiovascular disease mortality, particularly among elderly and obesity individuals. The findings underscore the significance of paying attention to and optimizing the management of hypotension in the general population.