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Optimal blood pressure control in treated hypertensive patients. Report from the Department of Health Hypertension
C J Bulpitt1, A J Palmer, A E Fletcher
1Division of Geriatric Medicine, Royal Postgraduate Medical School, London, United Kingdom.
Insights
Optimal blood pressure for hypertensive patients involves specific systolic and diastolic ranges for best survival. Lower treated systolic pressure (SBP) and diastolic pressure (DBP) generally correlate with improved outcomes in men and women.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Hypertension affects a significant portion of the adult population worldwide.
- Effective management of blood pressure is crucial for reducing cardiovascular morbidity and mortality.
- Identifying optimal blood pressure targets is essential for improving patient outcomes.
Purpose of the Study:
- To determine the optimal range of treated systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the best survival rates in hypertensive patients.
- To analyze the association between specific blood pressure levels and various mortality outcomes.
Main Methods:
- A cohort study was conducted involving 6214 hypertensive patients (3070 men, 3144 women) followed for a mean of 107 months.
- Age-adjusted relative hazard rates were calculated to assess the impact of SBP and DBP on total, cardiovascular, ischemic heart disease (IHD), and stroke mortality.
- Data were collected from specialist hypertension clinics and general practitioners.
Main Results:
- Optimal treated SBP for survival was observed in the range of 92-133 mm Hg for men and 96-148 mm Hg for women.
- Treated DBP < 95 mm Hg was associated with low total mortality in both sexes.
- Higher hazard rates for IHD and stroke mortality were noted with increasing SBP and DBP, particularly in men.
Conclusions:
- The best overall survival in hypertensive patients was associated with treated SBP < 134 mm Hg for men and < 149 mm Hg for women.
- A treated DBP < 95 mm Hg was linked to favorable survival outcomes.
- Blood pressure management should aim for these target ranges to optimize patient survival.
Background:
We wished to determine the range of treated systolic (SBP) and diastolic blood pressure (DBP) associated with the best survival in hypertensive patients.
Methods And Results:
We conducted a cohort study of patients enrolled in the DoH Hypertension Care Computer Project. Five specialist hypertension clinics (95% of patients) and general practitioners (5%) followed 6214 patients (3070 men and 3144 women) with an average age of 52 years for a mean of 107 months. Total, cardiovascular, ischemic heart disease, (IHD) and stroke mortality were the outcome measures. Age-adjusted relative hazard rates were calculated giving the effect on mortality of systolic or diastolic pressure being higher by 1 mm Hg. In men the optimal level of SBP for all four measures of mortality was the lowest pressure range observed, 92 to 133 mm Hg (median 127). For women the treated SBP range of 96 to 148 mm Hg (median 137) was associated with a low total mortality and also with low to moderate rates for IHD and stroke mortality. Relative hazard rates (P < .001) for IHD mortality were 1.010 for men and 1.013 for women and for stroke mortality were 1.018 and 1.021, respectively. The results were similar in men under and over the age of 60. SBP and DBP tended to be more important in younger than older women. For treated DBP in men, a pressure of 55 to 94 mm Hg (median 87) was associated with a low total mortality. The lowest stroke mortality in men was observed for a DBP range of 55 to 83 mm Hg (median 80) but with a tendency for an increase in IHD mortality. For women DBP < 95 mm Hg (range 55 to 94, median 87) also was associated with a low total mortality. IHD mortality in women was not closely related to treated DBP, relative hazard rate = 1.003, [95% confidence index (CI); 0.990,1.017] but the relative hazard rate for men was 1.011, (95% CI; 1.000, 1.022). The relative hazard rates for treated DBP and stroke were high at 1.035 and 1.028 for men and women, respectively (P < .001). IHD mortality increased in the one third of patients with the greatest fall in DBP on treatment, provided they were not initially in the one-third group with highest untreated DBP.
Conclusions:
The best overall survival was associated with a treated SBP of < 134 mm Hg in men and < 149 mm Hg in women and a treated DBP of < 95 mm Hg.
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