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Abstract: PO1791

Intensive Blood Pressure Control, Age, and All-Cause Mortality in the US Veterans Health Administration

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Yamada, Masaaki, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Griffin, Benjamin R., The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Wachsmuth, Jason, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Sambharia, Meenakshi, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Swee, Melissa L., The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Girotra, Saket R., The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Reisinger, Heather, Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Lund, Brian C., Center for Access & Delivery Research and Evaluation, Iowa City VAMC, Iowa City, Iowa, United States
  • Sarrazin, Mary Vaughan, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
  • Jalal, Diana I., The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, United States
Background

Intensive blood pressure (BP) control has been shown to improve survival in large clinical trials. It is unknown if intensive BP control is associated with improved outcomes amongst older adults in the real-world setting. We examined the association of intensive BP control with all-cause mortality in U.S. Veterans.

Methods

This retrospective analysis of Veterans Health Administration (VHA) data included Veterans with ≥2 systolic blood pressure (SBP) readings between January 2016 and December 2017 excluding those with mean SBP <100 mmHg to minimize reverse causation. Prevalent hypertension was defined as diagnostic codes related to hypertension, prescribed antihypertensive drugs, or ≥2 office BP of ≥130/90 mmHg. The following SBP categories were examined: <120, 120-129, and ≥130 mmHg (reference). We estimated the potential effect of SBP control on all-cause mortality and evaluated the potential interaction with age using a random-effect Cox regression model.

Results

Of the 1,959,003 Veterans, 18% had SBP <120 mmHg (n=352,684), 26% had SBP 120-129 mmHg (n=507,907), and 56% had SBP ≥130 mmHg (n=1,098,412). Mean SBP <120 and 120-129 mmHg associated significantly with mortality (the adjusted hazard ratio [aHR] was 1.30; 95% confidence interval [CI] 1.28-1.32 for SBP <120 mmHg and 1.03 [95% CI 1.01-1.04] for SBP 120-129 mmHg). There was a significant interaction between SBP category and age (p<0.01). Specifically, we observed a graded association of SBP <120 mmHg with all-cause mortality across increased age categories; this association was significant in the age categories ≥70 years (Figure 1).

Conclusion

Based on the analysis of real-world data of approximately 1.9 million Veterans, intensive BP control (SBP <120 mmHg) was associated with higher mortality specifically among older Veterans. These data have implications for BP management and suggest that intensive control of SBP may be harmful in older adults.

Funding

  • Veterans Affairs Support