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The relationship between a low treated blood pressure and IHD mortality: a report from the DHSS Hypertension Care
A E Fletcher1, D G Beevers, C J Bulpitt
1Division of Geriatric Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Insights
Treating blood pressure too low may increase ischemic heart disease (IHD) mortality in men, showing a U-shaped risk curve. This suggests careful management of hypertension is crucial to avoid potential harm from overly aggressive treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Public Health
Background:
- Controversy exists regarding whether intensive blood pressure lowering increases ischemic heart disease (IHD) mortality.
- The DHSS Hypertension Care Computer Project provides a dataset to investigate this relationship.
Purpose of the Study:
- To examine the influence of treated diastolic blood pressure (DBP) levels on all-cause and IHD mortality.
- To determine if a lower threshold for treated DBP is associated with increased IHD mortality.
Main Methods:
- Analysis of mortality data from 2,145 patients treated for hypertension for at least one year.
- Patients were followed for an average of four years, with mortality examined by quintiles of treated DBP.
- Age-adjusted IHD mortality rates were calculated for different DBP levels, stratified by sex and IHD history.
Main Results:
- All-cause mortality increased with higher treated DBP in both men and women.
- In men, IHD mortality exhibited a U-shaped distribution, with increased risk at the lowest (DBP < 86 mmHg) and highest (DBP ≥ 103 mmHg) treated DBP levels.
- This U-shaped pattern for IHD mortality was observed in men with and without a prior history of IHD, but not in women due to limited data.
Conclusions:
- Very low treated diastolic blood pressure may be associated with increased ischemic heart disease mortality in men.
- The findings suggest a potential J-shaped or U-shaped relationship between treated DBP and IHD mortality, highlighting the need for careful blood pressure management.
- The increased risk at lower DBP levels might be secondary to underlying ischemic heart disease.
Abstract:
The suggestion that treating blood pressure to below a certain level may increase IHD mortality is controversial. We investigated the influence of treated blood pressure on mortality in the DHSS Hypertension Care Computer Project. Mortality was examined by quintiles of treated diastolic blood pressure (DBP) in 2,145 patients treated for a minimum period of one year and subsequently followed for an average of four years. One hundred and seventy five patients died; 71 from IHD. In men and women all cause mortality increased with level of treated DBP. In men IHD mortality showed a U-shaped distribution with an age-adjusted rate of 15.2 per 1,000 person years in the lowest fifth (DBP less than 86 mmHg) comparable to that of 15.6 per 1,000 in the upper (DBP greater than or equal to 103 mmHg). A similar pattern could not be established in women due to very few IHD deaths. IHD mortality was further examined separately for men by prior history of IHD. An increase in IHD deaths in the lowest fifth of treated blood pressure was found for men both with and without a history of IHD. No similar pattern of IHD mortality was obtained for untreated DBP or treated systolic pressure. However, we cannot exclude the possibility that the risk of low treated DBP is secondary to ischaemic heart disease.