Background: Intensive blood #pressure (#BP) control reduces mortality and cardiovascular disease in clinical trials. However, real-world BP measurements often differ from standardized protocols. We evaluated the impact of real-world systolic BP on mortality among US Veterans.
Methods: We conducted a retrospective cohort study of Veterans with hypertension, defined by diagnostic codes, antihypertensive prescriptions, or ≥2 office BP readings ≥130/90 mm Hg in 2016 to 2017, with follow-up through March 2021. Systolic BP was treated as a time-dependent covariate and categorized into 7 groups: <110, 110-119, 120-129, 130-139, 140-149, 150-159, and ≥160 mm Hg. Discrete-time survival models assessed associations with all-cause mortality, adjusting for demographics, body mass index, and comorbidities. Stratified analyses were conducted based on cardiovascular disease and chronic kidney disease status.
Results: Among >2.3 million Veterans (mean age, 66 years; 36% with diabetes; 22% with cardiovascular disease; and 19% with chronic kidney disease), the lowest mortality risk was observed in those with systolic BP of 130 to 139 mm Hg. In this cohort, adjusted hazard ratios for all-cause mortality per year in each systolic BP category were 1.29 for BP <110; 1.03 for BP 110 to 119; 0.88 for BP 120 to 129; 0.83 for BP 130 to 139; 0.86 for BP 140 to 149; and 0.89 for BP 150 to 159 mm Hg, compared with a year with BP ≥160 mm Hg. These associations remained consistent across cardiovascular disease and chronic kidney disease subgroups.
Conclusions: Veterans with routine systolic BP of 130 to 139 mm Hg had the lowest mortality. These findings suggest that a higher BP target may be appropriate in clinical practice, especially for older adults with comorbidities.
https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25787
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