Key result
SBP over 160 mm Hg is linked to ~153% higher odds of poor subjective well-being.
Why the study?
Limited information exists regarding the association between subjective well-being and systolic blood pressure among hypertensive patients with coronary artery disease.
Is higher systolic blood pressure associated with worse subjective well-being in hypertensive patients with coronary artery disease?
RCT (n=22,576)
blinded-endpoint
randomized
Yes
Is higher systolic blood pressure associated with worse subjective well-being in hypertensive patients with coronary artery disease?
Odds Ratio: 2.53 (95% CI 2.41–2.66)
Higher on-treatment systolic blood pressure is associated with worse subjective well-being in hypertensive patients with coronary artery disease.
Should not yet influence BP targets in hypertensive CAD; hypothesis-generating for SBP effects on well-being and needs prospective confirmation.
BACKGROUND: Limited information exists regarding the association between subjective well-being (SWB) and systolic blood pressure (SBP) among hypertensive patients with coronary artery disease (CAD). HYPOTHESIS: We tested the hypothesis that there is an association between SBP and SWB. METHODS: We studied 22,576 hypertensive CAD patients > or = 50 years old in the INternational VErapamil SR-Trandolapril Study (INVEST), a randomized, blinded-endpoint trial of antihypertensive therapy in stable CAD patients. At each study visit, patients rated their SWB in the previous 4 weeks as "excellent," "good," "fair," or "poor" prior to SBP recordings. The outcome measure was SWB of "fair" or "poor." A longitudinal analysis using generalized estimating equations was performed to assess the association between SBP and odds of reporting fair/poor SWB, controlling for baseline SWB of fair/poor and angina reported during the study. RESULTS: Patients with higher SBP had higher odds of reporting fair/poor SWB. Specifically, compared with patients with SBP of < or = 120, patients with SBP 140-150 > 150 - < or = 160 and > 160 had about 90% and 2.5 times greater odds of feeling fair/poor, respectively (adjusted odds ratio [OR]: 1.5990, 95% confidence interval [CI]: 1.81-2.00 and adjusted OR: 2.53, 95% CI: 2.41-2.66). Those who reported angina in the 4 wks prior to a protocol visit had 2.2 times greater odds of reporting fair/poor SWB (adjusted OR: 2.2, 95% CI: 2.13-2.27). Female gender, black race, history of smoking, diabetes, myocardial infarction, stroke, and cancer also increased the odds of reporting fair/poor SWB. CONCLUSIONS: Among hypertensive CAD patients, higher on-treatment SBP is associated with greater odds of fair/poor SWB during follow-up.
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Gong et al. (2009) conducted an RCT in hypertensive coronary artery disease (n=22,576). Higher systolic blood pressure (>160 mm Hg) vs. Systolic blood pressure ≤120 mm Hg was evaluated on Subjective well-being of 'fair' or 'poor' (OR 2.53, 95% CI 2.41-2.66). Higher systolic blood pressure (>160 mm Hg) was associated with greater odds of reporting fair or poor subjective well-being compared to SBP ≤120 mm Hg (OR 2.53; 95% CI 2.41-2.66).