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Benefits and potential harm of lowering high blood pressure
Insights
Lowering blood pressure (BP) with atenolol may improve outcomes for hypertension patients. Optimal diastolic BP for reducing heart attack deaths in patients with ischemic heart disease appears to be 85-90 mm Hg.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension management aims to improve patient prognosis.
- The relationship between blood pressure (BP) control and mortality requires further investigation.
Purpose of the Study:
- To determine if lower blood pressure leads to better outcomes in patients with moderate-to-severe hypertension.
- To assess the prognostic value of treated blood pressure levels.
Main Methods:
- A cohort of 902 patients with moderate-to-severe hypertension were treated with atenolol (median dose 100 mg/day) for a mean of 6.1 years.
- Mortality data, including cause of death, were collected over the study period.
- Statistical analysis explored the relationship between initial and treated BP and mortality outcomes.
Main Results:
- Initial BP was a poor predictor of myocardial infarction (MI) mortality.
- Treated systolic blood pressure (SBP) was a strong predictor of MI mortality.
- A J-shaped relationship was observed between treated diastolic blood pressure (DBP) and MI mortality in patients with ischemic heart disease, with the lowest mortality at 85-90 mm Hg DBP.
Conclusions:
- Treated SBP is a significant predictor of MI mortality in hypertensive patients.
- For patients with ischemic heart disease, a treated DBP of 85-90 mm Hg may be associated with the lowest risk of death from myocardial infarction.
- Achieving specific diastolic blood pressure targets may be crucial for improving prognosis in certain hypertensive patient groups.
Abstract:
To investigate whether the lower the blood pressure (BP) the better the prognosis for the patient with moderate-to-severe hypertension, an assessment was made of 902 patients who received the beta 1-selective beta-blocker atenolol (median dose 100 mg a day), either alone or with other antihypertensive agents, for up to 10 years (mean 6.1). 91 died, 40 from myocardial infarction, 21 from stroke, and 30 from other causes. Initial BP was a poor predictor of mortality from myocardial infarction, whereas treated systolic blood pressure (SBP) was a strong predictor. There was a J-shaped relation, confined to those with evidence of ischaemic heart disease, between frequency of death from myocardial infarction and treated DBP (phase V); the frequency was lowest at treated DBP of 85-90 mm Hg and rose with treated DBP on either side of this range.