Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross‐sectional study in Uganda

The authors sought to describe the association between human immunodeficiency virus (HIV) and blood pressure (BP) levels, and determined the extent to which this relationship is mediated by body weight in a cross‐sectional study of HIV‐infected and HIV‐uninfected controls matched by age, sex, and neighborhood. Mixed‐effects models were fit to determine the association between HIV and BP and amount of effect of HIV on BP mediated through body mass index. Data were analyzed from 577 HIV‐infected and 538 matched HIV‐uninfected participants. HIV infection was associated with 3.3 mm Hg lower systolic BP (1.2‐5.3 mm Hg), 1.5 mm Hg lower diastolic BP (0.2‐2.9 mm Hg), 0.3 m/s lower pulse wave velocity (0.1‐0.4 mm Hg), and 30% lower odds of hypertension (10%‐50%). Body mass index mediated 25% of the association between HIV and systolic BP. HIV infection was inversely associated with systolic BP, diastolic BP, and pulse wave velocity. Comprehensive community‐based programs to routinely screen for cardiovascular risk factors irrespective of HIV status should be operationalized in HIV‐endemic countries.     

Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine‐Syracuse Longitudinal Study

The aim of the present study was to examine the relationship between orthostatic changes in blood pressure (BP) and cognition, with consideration given to cardiovascular risk factors and lifestyle variables. The cross‐sectional analysis included 961 community‐dwelling participants of the Maine‐Syracuse Longitudinal Study, for whom BP clinic measures (five sitting, five recumbent, and five standing) were obtained. Eighteen percent of participants had orthostatic hypotension (fall in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg upon standing) and 6% had orthostatic hypertension (rise in systolic BP ≥20 mm Hg). Orthostatic hypotension and hypertension defined using traditional criteria were unrelated to cognition with covariate adjustment. However, an examination of systolic and diastolic BP change independently revealed that participants with systolic orthostatic hypotension had poorer global cognition, verbal memory, and scanning and tracking scores than those with normal systolic BP change. The authors conclude that systolic orthostatic hypotension is significantly associated with reduced cognitive function.     

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross‐sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex‐matched cART‐naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART‐naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART‐naïve was 36.9% and 23.4%, P = 0.002 at BP ≥ 140/90 mm Hg and 57.2% and 42.3%, respectively, P = 0.0009, at BP ≥ 130/80 mm Hg. Factors associated with hypertension at BP ≥ 140/90 mm Hg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60‐2.71) per 10 years, and body mass index, 1.53 (1.24‐1.88) per 5 kg/m² rise. At BP ≥ 130/80 mm Hg, cART exposure, aOR of 1.77 (95% CI: 1.20‐2.63), family history of hypertension, aOR of 1.43 (1.12‐1.83), and hypertriglyceridemia, aOR of 0.54 (0.31‐0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.     

Automated office blood pressure is in agreement with awake and mean 24‐hour ambulatory blood pressure at the lower blood pressure range

Automated office blood pressure measurement eliminates the white coat effect and is associated with awake ambulatory blood pressure. This study examined whether automated office blood pressure values at lower limits were comparable to those of awake and mean 24‐hour ambulatory blood pressure. A total of 552 patients were included in the study, involving 293 (53.1%) men and 259 (46.9%) women, with a mean age 55.0 ± 12.5, of whom 36% were treated for hypertension. Both systolic and diastolic automated office blood pressures exhibited lower values compared to awake ambulatory blood pressure among 254 individuals with systolic automated office blood pressure <130 mm Hg (119 ± 8 mm Hg vs 125 ± 11 mm Hg, P < .0001 and 75 ± 9 mm Hg vs 79 ± 9 mm Hg, P < .0001 for systolic and diastolic BPs, respectively). Furthermore, the comparison of systolic automated office blood pressure to the mean 24‐hour ambulatory blood pressure levels also showed lower values (119 ± 8 vs 121 ± 10, P = .007), whereas the diastolic automated office blood pressure measurements were similar to 24‐hour ambulatory blood pressure values. Our findings show that when automated office blood pressure readings express values <130/80 mm Hg in repeated office visits, further investigation should be performed only when masked hypertension is suspected; otherwise, higher automated office blood pressure values could be used for the diagnosis of uncontrolled hypertension, especially in individuals with organ damage.     

High prevalence of masked uncontrolled morning hypertension in elderly non‐valvular atrial fibrillation patients: Home blood pressure substudy of the ANAFIE Registry

In the ANAFIE Registry home blood pressure subcohort, we evaluated 5204 patients aged ≥75 years with non‐valvular atrial fibrillation (NVAF) to assess blood pressure (BP) control, prevalence of masked hypertension, and anticoagulant use. Mean clinic (C) and home (H) systolic/diastolic BP(SBP/DBP) was 128.5/71.3 and 127.7/72.6 mm Hg, respectively. Overall, 77.5% of patients had hypertension; of these, 27.7%, 13.4%, 23.4%, and 35.6% had well‐controlled, white coat, masked, and sustained hypertension, respectively. Masked hypertension prevalence increased with diabetes, decreased renal function, age ≥80 years, current smoker status, and chronic obstructive pulmonary disease. By morning/evening average, 59.0% of patients had mean H‐SBP ≥ 125 mm Hg; 48.9% had mean C‐SBP ≥ 130 mm Hg. Early morning hypertension (morning H‐SBP ≥ 125 mm Hg) was found in 65.9% of patients. Although 51.1% of patients had well‐controlled C‐SBP, 52.5% of these had uncontrolled morning H‐SBP. In elderly NVAF patients, morning H‐BP was poorly controlled, and masked uncontrolled morning hypertension remains significant.     

Elevated Diastolic,But Not Systolic,Blood Pressure Measured in the Emergency Department Predicts Future Development of Hypertension in Normotensive Individuals

Elevated blood pressure (BP) is reported in many individuals without hypertension presenting to the emergency department (ED). Whether this condition represents a transient state or is predictive for the development of future hypertension is unknown. This observational prospective study investigated patients admitted to an ED without a diagnosis of hypertension in whom BP values were ≥140/90 mm Hg. The primary outcome was development of hypertension during follow‐up. Overall, 195 patients were recruited and at the end of follow‐up (average 30.14±15.96 months), 142 patients were diagnosed with hypertension (73%). The mean age (50±12.25 vs 48.31±13.9, P=.419) and sex distribution (78 men/64 women vs 24 men/20 women, respectively; P=.148) were similar in both groups. There were significant differences in systolic and diastolic BP between those who developed hypertension on follow‐up and those who did not (177.6 mm Hg±22.6/106.1 mm Hg±16.9 vs 168.6 mm Hg±18/95.2 mm Hg±12.2; P=.011 for systolic BP, P<.001 for diastolic BP). In multivariate analysis the only significant predictive factor for the development of hypertension was diastolic hypertension recorded in the ED (P=.03). Elevated diastolic, but not systolic, BP among patients presenting to the ED is associated with future development of hypertension in previously normotensive individuals.     

Race and sex differences in asleep blood pressure: The Coronary Artery Risk Development in Young Adults (CARDIA) study

Nocturnal hypertension and non‐dipping blood pressure are each associated with increased risk of cardiovascular disease. We determined differences in nocturnal hypertension and non‐dipping systolic/diastolic blood pressure among black and white men and women who underwent 24‐hour ambulatory blood pressure monitoring at the Coronary Artery Risk Development in Young Adults study Year 30 Exam in 2015‐2016. Asleep and awake periods were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as mean asleep systolic/diastolic blood pressure ≥ 120/70 mm Hg. Non‐dipping systolic and diastolic blood pressure, separately, were defined as a decline in awake‐to‐asleep blood pressure < 10%. Among 767 participants, the prevalence of nocturnal hypertension was 18.4% and 44.4% in white and black women, respectively, and 36.4% and 59.9% in white and black men, respectively. After multivariable adjustment and compared with white women, the prevalence ratio (95% confidence interval) for nocturnal hypertension was 1.65 (1.18‐2.32) for black women, 1.63 (1.14‐2.33) for white men, and 2.01 (1.43‐2.82) for black men. The prevalence of non‐dipping systolic blood pressure was 21.5% and 41.0% in white and black women, respectively, and 20.2% and 37.9% in white and black men, respectively. Compared with white women, the multivariable‐adjusted prevalence ratio (95% confidence interval) for non‐dipping systolic blood pressure was 1.66 (1.18‐2.32), 0.91 (0.58‐1.42) and 1.66 (1.15‐2.39) among black women, white men, and black men, respectively. Non‐dipping diastolic blood pressure did not differ by race‐sex groups following multivariable adjustment. In conclusion, black women and men have a high prevalence of nocturnal hypertension and non‐dipping systolic blood pressure.     

Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals

The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.     

Which blood pressure measurement,systolic or diastolic,better predicts future hypertension in normotensive young adults?

The impact of age‐related differences in blood pressure (BP) components on new‐onset hypertension is not known. A follow‐up examination of 93 303 normotensive individuals (mean age 41.1 years) who underwent a health checkup in 2005 was conducted every year for 8 years. The primary end point was new‐onset hypertension (systolic BP [SBP]/diastolic BP [DBP] ≥140/90 mm Hg and/or the initiation of antihypertensive medications with self‐reported hypertension). During the mean 4.9 years of follow‐up, 14 590 subjects developed hypertension. The impact of DBP on the risk of developing hypertension compared with optimal BP (SBP <120 mm Hg and DBP <80 mm Hg) was significantly greater than that of SBP in subjects younger than 50 years (hazard ratios, 17.5 for isolated diastolic high‐normal vs 10.5 for isolated systolic high‐normal [P<.001]; 8.0 for isolated diastolic normal vs 4.1 for isolated systolic normal [P<.001]). Among the subjects 50 years and older, the corresponding effects of DBP and SBP were similar. Regarding the risk of new‐onset hypertension, high DBP is more important than SBP in younger adults (<50 years) with normal or high‐normal BP.     

The association of nocturnal hypertension and nondipping blood pressure with treatment‐resistant hypertension: The Jackson Heart Study

Apparent treatment‐resistant hypertension (aTRH), nocturnal hypertension, and nondipping blood pressure (BP) have shared risk factors. The authors studied the association between aTRH and nocturnal hypertension and aTRH and nondipping BP among 524 black Jackson Heart Study participants treated for hypertension. Nocturnal hypertension was defined by mean nighttime systolic BP ≥120 mm Hg or diastolic BP ≥70 mm Hg. Nondipping BP was defined by mean nighttime to daytime systolic BP ratio >0.90. aTRH was defined by mean clinic systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg with three medication classes or treatment with four or more classes. The risk for developing aTRH associated with nondipping BP and nocturnal hypertension was estimated. After multivariable adjustment, participants with aTRH were more likely to have nocturnal hypertension (prevalence ratio, 1.20; 95% confidence interval, 1.03–1.39) and nondipping (prevalence ratio, 1.25; 95% confidence interval, 1.09–1.43). Over a median 7.3 years of follow‐up, nocturnal hypertension and nondipping BP at baseline were not associated with developing aTRH after adjustment.     

Efficacy and safety of twice‐ vs once‐daily dosing of lisinopril for hypertension

This retrospective cohort study compared administration of lisinopril twice daily and once daily for hypertension. Data were collected from an ambulatory electronic health record between 2011 and 2014. Patients previously receiving lisinopril 20 mg were placed into the once‐daily cohort if changed to 40 mg once daily or into the twice‐daily cohort if changed to 20 mg twice daily. Efficacy outcome measures were change in systolic blood pressure and diastolic blood pressure and achievement of blood pressure control (<140/90 mm Hg). Of 90 patients included (45 per cohort), the mean age was 61.8 years and 17.8% were black. Once‐ and twice‐daily administrations were associated with blood pressure reductions of 6.2/1.5 mm Hg and 16.5/5.9 mm Hg, with a 10.2/4.3 mm Hg greater reduction with twice‐daily administration (systolic blood pressure, P=.016; diastolic blood pressure, P=.068). Twice‐daily lisinopril dosing was associated with greater systolic blood pressure reductions compared with the same total daily dose administered once daily.     

Determination of optimal on‐treatment diastolic blood pressure range using automated measurements in subjects with cardiovascular disease—Analysis of a SPRINT trial subpopulation

Automated office blood pressure measurement (AOBPM) is recommended for diagnosing hypertension; however, optimal treatment targets using this method are not established. Discrepancies between automated and office measurements of blood pressure have been described, producing uncertainty regarding the use of AOBPM in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) results improved our understanding of target AOBPM systolic blood pressure (SBP) levels; however, diastolic blood pressure (DBP) targets remain unknown. Therefore, we sought to determine the optimal on‐treatment DBP range. The analysis was performed on the participants of the SPRINT trial who had hypertension and prior cardiovascular disease. We analyzed the data of 1470 participants (mean age 70.3 ± 9.3 years, 24.1% female) selected from the SPRINT trial database of National Heart, Lung and Blood Institute. The mean achieved SBP and DBP were 127.9 ± 10.7 and 68.3 ± 9.4 mm Hg, respectively. Most of the participants (57.4%) had a DBP lower than 70 mm Hg, while only 11.7% had DPB ≥80 mm Hg. Clinical composite endpoint was defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. There were 159 (10.8%) clinical endpoint events. The participants with on‐treatment AOBPM DBP range of 68.6‐78.6 mm Hg showed the lowest hazard risk of a clinical composite endpoint. These results correspond to the office DBP range of 70‐80 mm Hg recommended in ESC guidelines. This is the first attempt to determine the range of optimal DBP values using population‐based AOBPM in patients with prior cardiovascular disease.     

Association of interarm blood pressure difference with cardio‐cerebral vascular disease: A community‐based,cross‐sectional study

Interarm blood pressure difference (IAD) is a risk factor for peripheral artery disease and cardio‐cerebral vascular disease (CCVD). The current study examines the association of IAD with stroke and coronary heart disease in a Chinese community. A cross‐sectional study was conducted in Pudong New Area in Shanghai, China. A total of 10 657 residents aged 15 years and older were randomly selected through three‐stage sampling. Volunteers had systolic and diastolic blood pressure (BP) measured in both arms at recruitment, and IAD was defined in both arms as the absolute difference in BP. Medical records of study participants were reviewed by investigators to confirm measurements. Logistic regression models were used to assess the association between systolic interarm blood pressure difference (sIAD) and diastolic interarm blood pressure difference (dIAD) with stroke and coronary heart disease. Compared with dIAD <5 mm Hg, the multivariate adjusted odds ratio (OR) of stroke prevalence was 1.357 (95% CI 0.725‐2.542, P = 0.034) for dIAD ≥20 mm Hg and 1.702 (95% CI1.025‐2.828, P = 0.040) for dIAD between 15 and 19 mm Hg, and the multivariate adjusted OR of coronary heart disease prevalence was 1.726 (95% CI 1.093‐2.726, P = 0.019) for dIAD ≥20 mm Hg and 1.498 (95% CI 0.993‐2.261, P = 0.044) for dIAD between 15 and 19 mm Hg. The relationship between cardio‐cerebral vascular disease and dIAD was significant in a Chinese community population. Further cohort studies are needed to investigate the association of different levels of IAD with the incidence of cardiovascular and cerebrovascular diseases and subsequent mortality.     

Regression to the mean in home blood pressure: Analyses of the BP GUIDE study

The aim of our study was to estimate the size of regression to the mean with home blood pressure (BP) monitoring and compare with that for office BP. Office and home BP measures were obtained from the BP GUIDE (value of central Blood Pressure for GUIDing managEment for hypertension) study, in which 286 patients had BP measured every 3 months for 12 months. Patients were categorized by 10 mm Hg strata of baseline BP, and regression to the mean measures was calculated for home and office BP. High baseline home BP readings tended to be lower on long‐term follow‐up, and low baseline readings tended to be higher. For example, patients in the group with mean baseline home systolic BP ≥ 150 mm Hg had a mean baseline systolic BP of 156 mm Hg, which fell to 143 mm Hg at 12 months; and patients in the group with mean baseline home systolic BP < 120 mm Hg had a mean baseline systolic BP of 113 mm Hg which rose to 120 mm Hg at 12 months. Similar patterns were seen in intervention and control groups, and for diastolic BP. The regression dilution ratio for home systolic BP and diastolic BP was 0.52 and 0.64, respectively, compared to 0.40 and 0.55 for office systolic BP and diastolic BP, respectively. Home BP is subject to regression to the mean to a similar degree as office BP. These findings have implications for the diagnosis and management of hypertension using home BP.     

Diet‐independent relevance of serum uric acid for blood pressure in a representative population sample

A direct relationship between serum uric acid and blood pressure (BP) has been reported, but the possible confounding impact of diet on this association is unclear. The authors performed a cross‐sectional analysis in the representative German Health Interview and Examination Survey for Adults (n=6788, aged 18–79 years). In adjusted regression models considering dietary factors, each 1‐mg/dL higher uric acid value was associated with a 1.10‐mm Hg (P=.0002) and a 0.60‐mm Hg (P=.04) higher systolic BP among participants younger than 50 years and participants 50 years and older, respectively. For diastolic BP, uric acid was a significant predictor (β=0.71 mm Hg, P=.0001) among participants younger than 50 years and for participants 50 years and older without antihypertensive treatment. Adjusted odds ratios of hypertension for participants with hyperuricemia were broadly similar in younger (odds ratio, 1.71; P=.02) and older (odds ratio, 1.81; P=.0003) participants. Uric acid is a significant predictor of systolic BP and hypertension prevalence in the general adult population in Germany independently of several known dietary BP influences.     

Elevated Serum Level of Interleukin 17 in a Population With Prehypertension

Cytokines play an important role in the pathogenesis of hypertension. The authors hypothesized that interleukin 17 (IL‐17) might contribute to the prehypertensive state. This study evaluated the relationship between serum levels of IL‐17 and prehypertension. A total of 394 participants were enrolled, after excluding for hypertension or treated hypertension, and divided into two groups (optimal blood pressure [BP] and prehypertension) based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification of BP. Optimal BP was defined as systolic BP <120 mm Hg and diastolic BP <80 mm Hg. Prehypertension was defined as systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg. IL‐17A levels were determined by enzyme‐linked immunosorbent assay. The mean serum IL‐17 concentration in the prehypertension group was significantly higher than in the optimal BP group. The cohort was divided into quartiles Q1 (≤3.5 ng/L), Q2 (3.60 to 6.10 ng/L), Q3 (6.20 to 10.00 ng/L), and Q4 (≥10.10 ng/L) based on IL‐17 levels. The Q2 to Q4 groups had increasing odds ratios for having prehypertension compared with the Q1 group. Elevated serum IL‐17 was accompanied by a rise in systolic BP. Thus, increased serum IL‐17 levels are associated with prehypertension.     

Evaluation of Criteria to Detect Masked Hypertension

The prevalence of masked hypertension (out‐of‐clinic daytime systolic/diastolic blood pressure (SBP/DBP) ≥135/85 mm Hg on ambulatory blood pressure monitoring [ABPM] among adults with clinic SBP/DBP <140/90 mm Hg) is high. It is unclear who should be screened for masked hypertension. The authors derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mm Hg and ≥217 mm Hg and prehypertension status was 98.5%, 71.5%, and 82.5%, respectively. Using National Health and Nutrition Examination Survey data (n=11,778), the authors estimated that these thresholds would refer 118.6, 44.4, and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM.     

Traffic congestion and blood pressure elevation: A comparative cross‐sectional study in Lebanon

This comparative cross‐sectional study examines the association between traffic congestion and elevation of systolic and/or diastolic blood pressure levels among a convenience sample of 310 drivers. Data collection took place during a gas station pause at a fixed time of day. Higher average systolic (142 vs 123 mm Hg) and diastolic (87 vs 78 mm Hg) blood pressures were detected among drivers exposed to traffic congestion compared with those who were not exposed (P<.001), while controlling for body mass index, age, sex, pack‐year smoking, driving hours per week, and occupational driving. Moreover, among persons exposed to traffic congestion, longer exposure time was associated with higher systolic and diastolic blood pressures. Further studies are needed to better understand the mechanisms of the significant association between elevated blood pressure and traffic congestion.     

Association of normal systolic blood pressure in the emergency department with higher in‐hospital mortality among hypertensive patients

Blood pressure is commonly elevated at the hospital emergency department (ED), especially among hypertensive patients. The aim of the study was to determine the association between ED systolic blood pressure (SBP) and in‐hospital mortality among hypertensive patients. The authors retrospectively retrieved records of hypertensive patients who were hospitalized during a seven‐year period. The authors examined the association between SBP and in‐hospital mortality rate, adjusted for demographics, heart rate, comorbidities, laboratory results, and hospital ward. Overall, 96 423 patients were included. Compared to patients with SBP 110‐139 mm Hg, the adjusted odds ratios were 4.1 (95% CI, 3.7‐4.6) with SBP <90, 1.6 (95% CI, 1.4‐1.7) with SBP 90‐109, 0.7 (95% CI, 0.6‐0.7) with SBP 140‐159, 0.7 (95% CI, 0.6‐0.7) with SBP 160‐179, 0.7 (95% CI, 0.6‐0.8) with SBP 180‐199, 0.9 (95% CI, 0.7‐1.1) with SBP 200‐219, and 1.1 (95% CI, 0.7‐1.7) with SBP ≥220 mm Hg. Thus, SBP levels of 110‐139 mm Hg were associated with higher in‐hospital mortality in comparison with elevated SBP up to 200 mm Hg.