Frequency and Prognosis of Treated Hypertensive Patients According to Prior and New Blood Pressure Goals

Area of Science:

• Cardiology
• Hypertension Management
• Public Health

Background:

• Recent US and European guidelines advocate for more stringent blood pressure (BP) treatment goals.
• Prior treatment focused on office BP <140/90 mm Hg, with new goals including <130/80 mm Hg.

Purpose of the Study:

• To evaluate the frequency of achieving new office BP goals and assess all-cause mortality risk based on office and 24-hour ambulatory BP monitoring (ABPM) criteria.
• To compare mortality risk across different BP strata defined by new office BP goals and ABPM control.

Main Methods:

• Analysis of 9784 hypertensive patients from the Spanish ABPM registry.
• Stratification of patients based on office BP goals (<140/90, 130-139/80-89, <130/80 mm Hg) and ABPM criteria (<130/80 mm Hg for European, <125/75 mm Hg for US guidelines).
• Multivariable Cox models used to assess 5-year all-cause mortality risk.

Main Results:

• Mortality risk was significantly elevated only when 24-hour ABPM exceeded goal, irrespective of office BP control (Hazard Ratio 2.4-2.9, P<0.001).
• 34.4% of patients achieved the new office BP goal (<130/80 mm Hg).
• 31.6% and 53.7% of patients did not achieve ABPM goals (<130/80 and <125/75 mm Hg, respectively), with a mean office systolic BP of 129 mm Hg in this group.

Conclusions:

• The new office BP goal (<130/80 mm Hg) is attainable for many hypertensive patients.
• 24-hour ABPM is a critical indicator for mortality risk, even when office BP appears controlled.
• Focusing solely on office BP may underestimate cardiovascular risk in hypertensive patients.