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Time in Therapeutic Range, as a Determinant of All-Cause Mortality in Patients With Hypertension
Michael Doumas1, Costas Tsioufis2, Ross Fletcher2
1VA Medical Center and George Washington University, Washington, DC.
Insights
Maintaining systolic blood pressure (BP) within the 120-140 mm Hg therapeutic range significantly reduces all-cause mortality in veterans. Consistent BP control over time is crucial for improving health outcomes and longevity.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Gerontology
Background:
- Systolic blood pressure (BP) reduction below 140 mm Hg improves outcomes, but optimal targets remain debated.
- Studies suggest a 120-140 mm Hg range, with risks potentially increasing outside this window.
- This study investigated the impact of consistent BP control within the 120-140 mm Hg range on mortality in US veterans.
Purpose of the Study:
- To test the hypothesis that maintaining systolic BP within the 120-140 mm Hg therapeutic range (time in therapeutic range) is a key determinant of all-cause mortality.
- To evaluate the association between the duration of BP control within the therapeutic range and mortality risk.
- To inform clinical practice regarding the importance of consistent BP management.
Main Methods:
- Analysis of 689,051 US veterans over 10 years from 15 Veterans Administration Medical Centers.
- Classification of participants into hypertensive, intermediate hypertensive, and normotensive groups based on BP readings.
- Quantification of time spent within, above, or below the 120-140 mm Hg therapeutic range, analyzed in quartiles.
Main Results:
- Hypertensive participants had significantly higher mortality rates (11.5%) compared to intermediate (8%) and normotensive (1.9%) groups.
- For hypertensive individuals, mortality was lowest when BP was consistently within the therapeutic range (6.5%), and highest when consistently below (33.1%) or above (21.9%).
- A dose-response relationship was observed: as the proportion of time within the therapeutic range decreased, all-cause mortality progressively increased.
Conclusions:
- Consistent control of systolic BP within the 120-140 mm Hg range demonstrates a strong inverse association with all-cause mortality in a large veteran cohort.
- The duration of time spent within the therapeutic BP range is a significant predictor of mortality.
- Monitoring the consistency of BP control in clinical practice is essential for optimizing patient outcomes and reducing mortality risk.
Background:
Accumulating evidence indicates that reducing systolic blood pressure (BP) to <140 mm Hg improves health outcomes; however, an optimal level has not yet been determined. Many population studies or post hoc analyses suggest a target systolic BP between 120 and 140 mm Hg with increased risk above and below that range. We tested the hypothesis that consistent control of systolic BP between 120 and 140 mm Hg-time in therapeutic range-is a strong determinant of all-cause mortality among US veterans.
Methods And Results:
A total of 689 051 individuals from 15 Veterans Administration Medical Centers were followed over a 10-year period. Participants were classified as hypertensive, intermediate hypertensive, and normotensive according to the number of elevated BP recordings (>3, 1 or 2, and none, respectively). Time within, above, or below therapeutic range (120-140 mm Hg) was considered in quartiles and related to all-cause mortality. The study population consisted of 54% hypertensive, 19.9% intermediate, and 26.1% normotensive participants; the corresponding mortality rates for the 3 groups were 11.5%, 8%, and 1.9%, respectively (P<0.0001 for all comparisons). Mortality rates for hypertensive participants with BP consistently within, above, or below the therapeutic range were 6.5%, 21.9%, and 33.1%, respectively (P<0.0001 for all comparisons). Mortality rates in hypertensive participants increased from 6.5% in the most consistently controlled quartile (>75%) to 8.9%, 15.6%, and 23.5% towards the less consistently controlled quartiles (50-75%, 25-50%, and <25%, respectively; P<0.0001 for all comparisons).
Conclusions:
An inverse and gradual association between time in therapeutic range and all-cause mortality was observed in this large veteran cohort. Consistency of BP control over time is a strong determinant of all-cause mortality, and consistency of BP control should be monitored in everyday clinical practice.
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