Abstract 19356: Mortality Trends in Hypertensive Patients Indicate Optimal Blood Pressure Targets
Introduction: The impact of blood pressure control on health outcomes has been shown in many double blind randomized clinical trials. However an optimal blood pressure level for systolic or diastolic BP and its effect on mortality has not been shown.
Methods: We examine mortality rates in hypertensive patients from 15 Veterans Administration hospitals from January 2000 to December 2007. We divided patients in groups based on achieved last systolic blood pressure (SBP), and diastolic blood pressure (DBP) and age as follows: younger patients <55 yo (N=116,854), middle age 55–69 yo (N=169,599), older patients 70–79 yo (N=120,563) and > 80 yo (N=53,444). We examined mortality rates based on achieved SBP. Patients with systolic BP < 100 were excluded. Control of BP was present when SBP is <140 and DBP <90, and was achieved using the VA Electronic Health Record using CPRS-VistA.
Results: During the follow up period, 2000 to 2007, blood pressure control improved in younger patients from 58% to 73%, in middle aged patients from 52% to 72%, in older patients from 43% to 73%, and in octogenarians from 42% to 74%. During the 7 year follow up period, 6.5%, 10.2%, 20.0% and 27.5% (P<0.0001 for all comparisons) of patients (younger to older) died. Based on achieved BP, the lowest mortality rate was in the range of 130–139 systolic and 70–89 diastolic BP (see figure). BPs above or below these ranges were associated with increased mortality in all age groups. While optimal SBP is the same in all age groups (130–139), optimal DBP are lower (70–79) in octogenarians and older patients then in middle aged and younger patients (80–89) P<0.05.
Conclusions: These data indicate that: 1) In this hypertensive population high rates of control can be achieved, 2) Controlling BP to optimal targets 130–139 systolic and 70–89 diastolic improves mortality, 3) The increased mortality rates associated with the low SBP or low DBP needs further investigation.
- © 2010 by American Heart Association, Inc.