Abstract 19229: Effect of Blood Pressure Control on Mortality in Patients With Hypertension - Using the VA National Database
Medical centers are being presented with an increasing number of hypertensives, and controlling Blood Pressure (BP) has become a healthcare imperative. The outcome of this control can be measured by analysis of mortality. The VA has used an Electronic Health Record with reminders since 1998 to detect and manage hypertension. Vital signs from the entire VA database were analyzed between 2001 and August 2011. Of 8,868,500 patients, 4,353,382 had elevations >140 systolic or >90 on three separate days. BP control was divided into patients who were controlled >66%, 66 to 33%, and <33% of the time.
Mortality improvement varied with age. The mortality decreased in patients with 66% control compared to those with 33% control. This decreased mortality was 10.4% points for those under 70 years old, 13.4% points for 70 - 90 years old, and only .8% for those over 90. The % died was compared between patients with hypertension and those without hypertension in different age groups. The age groups were ≤ 50, 50 - <60, 60 - <70, 70 - <80, 80 - <90 and ≥90. The % point difference between groups and % increase in mortality for patients with hypertension in the ages ≤ 50 was 6.5 - 175%, 50 - <60 was 4.2 - 28%, 60 - <70 was 5.1 - 24%, 70 - <80 was 1.7 - 3.5%, 80 - <90 was .3 - .4%, and for those ≥90 minus .3 - minus .5%. Thus difference in mortality in hypertensive and normotensive groups decreases in higher age groups to the point where a slightly higher percent die in patients without hypertension than with hypertension in patients over 90.
Control of BP over time is associated with decreased mortality in all age groups less than 90. After 90 control of BP has very little effect on mortality. Mortality in hypertensive patients is more than in normotensive patients until 90. When mortality is higher for patients with hypertension than those without, control of hypertension decreases mortality.
- © 2013 by American Heart Association, Inc.