Abstract 17842: Blood Pressure Control That Reduces Mortality and Cardiovascular Events From 2000 to 2014 for Patients in the Veterans Administration Healthcare System
Background: The Veterans Affairs (VA) Electronic Health Record (EHR) contains blood pressure (BP) measurements over many years and can examine what level of BP control affects mortality and adverse cardiovascular (CV) events.
Methods: We examined changes in BP (2000-2014) from 152 VA hospitals and 819 outpatient clinics in relation to all-cause mortality. Hypertension (HTN) was defined as systolic BP >140 or diastolic BP >90 mmHg on 3 separate days. The level of BP control was determined by averaging all available BPs after HTN was diagnosed. Eight levels of mean BP were examined for the whole population, by racial groups (White and Black), age and for presence or absence of diabetes. The main outcome measures were all cause mortality and non-fatal CV events (stroke, heart failure (HF), and acute kidney injury).
Results: There were 8,813,000 patients, of which 3,160,608 had HTN. Most patients (89%) had a mean systolic BP between 120 and 150. The lowest mortality was in patients with BP between 120 - 130 for non-diabetics, and 130 - 140 for diabetics (p<0.001, see diagrams below). Mortality increased to above 10% for all patients when mean systolic BP was above 150 or below 110 (p<0.001). Non-diabetic patients >60 y/o with mean systolic BP of 130 - 140 had 15% lower mortality compared to those with a mean systolic BP of 150 - 160 (p<0.001). Blacks < 60 y/o had better survival than Whites at similar levels of BP control. Blacks had higher non-fatal CV event rates than Whites (47% increase in stroke), (40% increase in HF), and (64% increase in kidney failure). At mean BP control rates between 120 - 140 non-fatal CV events of stroke and kidney failure were reduced among Blacks but not among Whites.
Conclusion: The mean systolic blood pressure control that produced the lowest mortality was 120 - 130 for non-diabetics and 130 - 140 for diabetics. Controlling non-diabetics to a level of BP between 120 and 130 mmHg can further reduce mortality and nonfatal CV events (in agreement with the SPRINT study).
Author Disclosures: R.D. Fletcher: None. R.L. Amdur: None. R. Kheirbek: None. A. Ahmed: None. F. Alemi: None. D. Maron: None. C. Faselis: None. R.E. Jones: None. V. Papademetriou: None.
- © 2016 by American Heart Association, Inc.