Abstract 15885: On Treatment Time in Therapeutic Range is a Strong Determinant of All Cause Mortality Among Patients with Hypertension
Introduction: Elevated blood pressure (BP) markedly increases the risk of cardiovascular events and all cause mortality. Numerous prospective studies and cohort analyses suggest that reducing systolic BP to <140 mmHg improves health outcomes, but an optimal level has not been determined. In fact retrospective analyses based on last or achieved BP, suggest a J shape curve at systolic BP <120 mmHg. Hypothesis: We assessed the hypothesis that time In Therapeutic Range ( ITR) is a strong determinant of all cause mortality among treated patients with hypertension.
Methods: For the purpose of this study we considered as optimal on treatment systolic BP the range of 120 to 140 mmHg ( Therapeutic Range, TR). We examined the relationship of time in therapeutic range (ITR) and all cause mortality, over a 10 year period (May 2000 to June 2010) in 371,996 patients with treated hypertension followed in 15 Veterans Administration Medical centers. Systolic BP >140 mmHg was considered above TR (ATR) and systolic BP<120mmHg was considered below TR (BTR).Time In, Above or Below TR, was considered in quartiles and related to all cause mortality. A total of 53,452 patients died during the follow up period. Death rates were as shown on table:
Conclusions: In conclusion data from this study suggest that long term maintenance of systolic BP ITR ( between 120 and 140 mmHg) over a 10 year period is associated with the lowest risk of death. The risk is minimized in those patients who maintain systolic BP ITR >75% of time, but risk is only minimally increased if systolic BP is maintained ITR at least 50% of time. Maintaining systolic BP ATR or BTR markedly increases the risk of all cause mortality
- © 2012 by American Heart Association, Inc.