Abstract: FR-PO740
Routine Office Blood Pressure and All-Cause Mortality Among US Veterans
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Sambharia, Meenakshi, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Reisinger, Heather, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Randomized controlled trials have provided accumulating evidence of benefits from intensive blood pressure lowering utilizing standardized blood pressure measurement in individuals at high risk of cardiovascular disease (CVD). However, it remains unclear whether intensive blood pressure control, based on routine office BP, is associated with improved outcomes. Here, we examined the association of routine office blood pressure categories and all-cause mortality in US Veterans.
Methods
We identified Veterans with prevalent hypertension defined as International Classification of Disease-10 codes related to hypertension, prescribed antihypertensive drugs, or ≥2 office BP of ≥130/90 mmHg who had ≥2 systolic blood pressure (SBP) readings from 2016-2017 and follow-up through March 2021. We examined the association of mean SBP control (3 groups: <120, 120-129, and ≧130 mmHg) with all-cause mortality by using time-dependent Cox regression models adjusted for demographics, body mass index, and comorbid conditions defined by diagnostic codes after excluding individuals with mean SBP <100 mmHg. In these models, we analyzed effects in the high-risk individuals with CVD as sensitivity analysis.
Results
Of the 1,284,131 hypertensive Veterans, 10% (n=128,493) had mean SBP <120 mmHg at baseline; 20% (n=262,887) had 120-129 mmHg; and 70% (n=892,870) had ≧130 mmHg. 28% had previous CVD. Mean SBP <120 and 120-129 mmHg categories were associated with improved mortality compared to ≧130 mmHg (Table 1). Of note, SBP category 120-129 mmHg had the lowest mortality. Sensitivity analysis revealed similar findings among Veterans with prior history of CVD (Table 1).
Conclusion
Routine office SBP categories <130 mmHg (vs ≧130 mmHg) were associated significantly with reduced mortality among Veterans with prevalent hypertension independent of pre-existing CVD status.
Table 1. Systolic blood pressure group and mortality risk
| Patients | Mean SBP (mmHg) | Hazard ratio | 95% confidence interval |
| All patients | <120 | 0.912 | 0.908-0.916 |
| 120-129 | 0.654 | 0.651-0.658 | |
| ≧130 | 1 (reference) | ||
| History of cardiovascular disease | <120 | 0.913 | 0.907-0.919 |
| 120-129 | 0.644 | 0.638-0.651 | |
| ≧130 | 1 (reference) |
BP: blood pressure; SBP: systolic blood pressure
Funding
- Veterans Affairs Support