Abstract 1076: Impact of Blood Pressure Control on All Cause Mortality in a Clinical Practice Setting
Introduction: Hypertension treatment and control results in improvement in health outcomes. However the expected benefits from antihypertensive treatment have not been elucidated in the primary care setting.
Methods: In the late 1990s, the Washington DC VAMC employed a battery of recommendations to improve blood pressure (BP) control. In 42,346 patients with multiple BP measurements, systolic and diastolic BPs were averaged for each day of a mean period of 98 months of follow up and accordingly they were allocated to one of 3 groups: Always Controlled (n=8,144, 19.2%): BP controlled for all days of follow up, Partially Controlled (n=19,337, 45.7%): BP elevated up to 50% of days (28.2%±13.7) of follow up, and Not Controlled (n=14,865, 35.1%): BP elevated >50% of days (74.5%±14.8) of follow up.
Results: During the follow up period 6,293 (14.9%) died. Of those 816 patients (10%) died in the Always Controlled group, 2,988 (15.5%) in the partially controlled group and 2,489 (16.7%) patients died in the Not Controlled group(p<0.0001 for all comparisons). Cox proportional hazard analysis, adjusted for age, sex, heart failure, diabetes mellitus, and BMI demonstrated a relative risk of 1.24 (CI 1.14 –1.36) for the Partially Controlled group and RR 1.31(CI 1.20 –1.43) for the Not Controlled group compared to the Always Controlled group. Significant differences were also noted comparing the Partially Controlled to the Not Controlled group (p<0.0012) (Figure⇓).
High rates of BP control can be achieved in the usual clinical practice setting,
Sustained BP control resulted in the greatest reduction in mortality risk,
Partial BP control also provided mortality reduction.