Compared to a systolic BP of 130-139 mmHg, both lower (<110 mmHg; HR 4.1) and higher (≥170 mmHg; HR 4.9) treated blood pressures were associated with increased risk of mortality and ESRD.
Cohort (n=398,419)
Hazard Ratio: 4.9 (95% CI 4.4–5.5)
Background Medical literature or clinical guidelines have not adequately addressed the ideal blood pressure (BP) treatment targets for survival and renal outcome. Objective To evaluate ranges of treated BP in a large hypertension population and compare risk of mortality and end stage renal disease (ESRD). Methods A retrospective cohort study within the Kaiser Permanente Southern California health system was performed from January 1, 2006 to December 31, 2010. Treated hypertensive individuals age >/=18 years were studied. Cox proportional hazards regression models were used to evaluate the risks (hazard ratios) for mortality and/or ESRD among different BP categories with and without stratification for diabetes mellitus (DM) and older age. Results Among 398,419 treated hypertensive individuals (30% with DM), mortality occurred in 25,182 (6.3%) and ESRD in 4,957 (1.2%). Adjusted HR (95% CI) for composite mortality/ESRD in systolic BPs /=170 compared to 130-139 mmHg were 4.1 (3.8,1.3), 1.8 (1.7,1.9), 1.1 (1.1,1.1), 1.4 (1.4,1.5), 2.3 (2.2,2.5), 3.3 (3.0,3.6), and 4.9 (4.4,5.5) respectively. Diastolic BPs 60-79 mmHg were associated with the lowest risk. The nadir systolic and diastolic BP for the lowest risk was 137 and 71 mmHg respectively. Stratified analyses revealed that the DM population had a similar HR curve but a lower nadir at 131 and 69 mmHg but age >/=70 had a higher nadir (140 and 70 mmHg). Conclusions Both higher and lower treated BPs compared to 130-139 mmHg systolic and 60-79 mmHg diastolic ranges had worsened outcomes. Our study adds to the growing uncertainty about BP treatment targets.
“Physicians have often emphasized the need to bring a patient's blood pressure down as low as possible for the best outcomes. However, the findings of our study suggest that treating patients with high blood pressure too aggressively may potentially lead to poor health outcomes.”
Sim et al. (Fri,) conducted a cohort in Hypertension (n=398,419). Treated systolic blood pressure <110 to ≥170 mmHg vs. Systolic blood pressure 130-139 mmHg was evaluated on Composite mortality and end-stage renal disease (ESRD) (HR 4.9, 95% CI 4.4-5.5). Compared to a systolic BP of 130-139 mmHg, both lower (<110 mmHg; HR 4.1) and higher (≥170 mmHg; HR 4.9) treated blood pressures were associated with increased risk of mortality and ESRD.