Association of optimal blood pressure with mortality in patients taking antihypertensive medications

We investigated the relationship between blood pressure (BP) and mortality in patients taking antihypertensive medications in the Korean using data from the 2007‐2015 Korean National Health and Nutrition Examination Surveys. A total of 6601 patients aged 30‐74 years were included. Systolic BP (SBP) and diastolic BP (DBP) were both divided into four groups as follows: SBP < 120, 120 ≤ SBP ≤ 129 130 ≤ SBP ≤ 139, and SBP ≥ 140; DBP < 70, 70 ≤ DBP ≤ 79, 80 ≤ DBP ≤ 89, and DBP ≥ 90. The survival rates and hazard ratios were evaluated using Kaplan‐Meier curves and multivariable Cox regression analyses. To evaluate the predictability of all‐cause mortality according to SBP and/or DBP, we calculated Harrell''s concordance‐index. The lowest DBP group had a high risk of mortality regardless of the SBP status. The group with DBP < 70 mm Hg and SBP ≥ 140 mm Hg showed the highest mortality. The discriminatory ability calculated using Harrell''s C‐indexes was greater for the combination of SBP and DBP compared to DBP or SBP alone. These results suggest that it is more effective to simultaneously evaluate the effect of SBP and DBP to predict mortality; clinicians should manage DBP < 70 mm Hg when treating hypertensive patients.     

Association of low diastolic blood pressure with all-cause death among US adults with normal systolic blood pressure

Although the effect of intensive systolic blood pressure lowering is widely recognized, treatment-related low diastolic blood pressure still worrisome. This was a prospective cohort study based on the National Health and Nutrition Examination Survey. Adults (≥20 years old) with guideline-recommended blood pressure were included and pregnant women were excluded. Survey-weighted logistic regression and cox models were used for analysis. A total of 25 858 participants were included in this study. After weighted, the overall mean age of the participants was 43.17 (16.03) years, including 53.7% women and 68.1% non-Hispanic white. Numerous factors were associated with low DBP (<60 mmHg), including advanced age, heart failure, myocardial infarction, and diabetes. The use of antihypertensive drugs was also associated with lower DBP (OR, 1.52; 95% CI, 1.26–1.83). DBP of less than 60 mmHg were associated with a higher risk of all-cause death (HR, 1.30; 95% CI, 1.12–1.51) and cardiovascular death (HR, 1.34; 95% CI, 1.00–1.79) compared to those with DBP between 70 and 80 mmHg. After regrouping, DBP <60 mmHg (no antihypertensive drugs) was associated with a higher risk of all-cause death (HR, 1.46; 95% CI, 1.21–1.75). DBP <60 mmHg after taking antihypertensive drugs was not associated with a higher risk of all-cause death (HR, 0.99; 95% CI, 0.73–1.36). Antihypertensive drug is an important factor contributing to DBP below 60 mmHg. But the pre-existing risk does not increase further with an additional reduction of DBP after antihypertensive drugs treatment.     

Lower systolic blood pressure is associated with greater mortality in people aged 85 and older

OBJECTIVES: To investigate the association between blood pressure and mortality in very old people. DESIGN: Population‐based cohort study. SETTING: County of Västerbotten, Sweden. PARTICIPANTS: Half of all subjects aged 85 and all of those aged 90 and 95 and older (N=348) in one urban and five rural municipalities in the north of Sweden. MEASUREMENTS: Among others, supine blood pressure, Mini‐Mental State Examination, Barthel Index of activities of daily living, Mini Nutritional Assessment, and body mass index. Information on diagnoses, medications, and 4‐year mortality was collected. Associations between blood pressure and mortality were investigated using Cox regression analyses, controlling for a number of diagnoses and health factors. RESULTS: Baseline systolic blood pressure (SBP), diastolic blood pressure, and pulse pressure were all inversely associated with mortality within 4 years according to univariate analysis. SBP was the strongest predictor. In Cox regression analyses, low SBP (≤120 mmHg) correlated with greater 4‐year all‐cause mortality alone and when controlling for health status. This connection persisted after exclusion of deaths within the first year. There was a tendency toward a U‐shaped mortality curve for the adjusted model, with SBP of 164.2 mmHg (95% confidence interval=154.1–183.8 mmHg) being associated with the lowest mortality. CONCLUSION: Lower SBP seems to be associated with greater mortality in people aged 85 and older, irrespective of health status. There are indications of a U‐shaped correlation between SBP and mortality, and the optimal SBP for this age group could be above 140 mmHg.     

Association between plasma retinol levels and the risk of all‐cause mortality in general hypertensive patients: A nested case‐control study

To evaluate the association between plasma retinol levels with all‐cause mortality and investigate the possible effect modifiers in general hypertensive patients with no previous cardiovascular disease (CVD). This case‐control study was nested in the China Stroke Primary Prevention Trial (CSPPT), a randomized, double‐blind, controlled trial conducted in 32 communities in Anhui and Jiangsu provinces in China. The current study included 617 cases of all‐cause mortality and 617 controls matched on age (≤1 year), sex, treatment group, and study site. All‐cause mortality was the main outcome in this analysis, which included death due to any reason. The median follow‐up duration was 4.5 years. Overall, there was a U‐shaped relation of plasma retinol with all‐cause mortality. In the threshold effect analysis, the risk of all‐cause mortality significantly decreased with the increase in plasma retinol (per 10 μg/dL increments: OR, 0.73; 95% CI: 0.61‐0.87) in participants with plasma retinol <58.3 μg/dL and increased with the increase in plasma retinol (per 10 μg/dL increments: OR, 1.08; 95% CI: 1.01‐1.16) in those with plasma retinol ≥58.3 μg/L. In participants with plasma retinol <58.3 μg/dL, a stronger inverse association was observed in those with higher time‐averaged SBP (≥140 vs <140 mm Hg; P‐interaction = .034), or higher vitamin E levels (≥11.5 [quartile 4]; vs <11.5 μg/mL; P‐interaction = .013). The present study demonstrated that there was a U‐shaped relationship of plasma retinol levels with the risk of all‐cause mortality in general hypertensive patients, with a turning point around 58.3 μg/dL.     

Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Hypertension is the most common comorbidity in patients with coronavirus disease 2019 (COVID‐19) and increases in‐hospital mortality. Day‐by‐day blood pressure (BP) variability (BPV) is associated with clinical outcomes in hypertensive patients. However, little information is available on the association of BPV with the outcomes of COVID‐19 patients with hypertension. This study aimed to demonstrate whether day‐by‐day in‐hospital BPV had prognostic significance in these patients. The authors included 702 COVID‐19 patients with hypertension from Huoshenshan Hospital (Wuhan, China), who underwent valid in‐hospital BP measurements on at least seven consecutive days. Day‐by‐day BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM). Overall, patients with severe COVID‐19 and non‐survivors had higher BPV than moderate cases and survivors, respectively. Additionally, higher BPV was correlated with greater age and higher levels of C‐reactive protein, procalcitonin, high‐sensitive cardiac troponin I, and B‐type natriuretic peptide. In multivariable Cox regression, SD of systolic BP (SBP) was predictive of mortality [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.05–1.30] as well as acute respiratory distress syndrome (ARDS) (HR 1.09, 95% CI 1.01–1.16). Similar trends were observed for CV and VIM of SBP, but not indices of diastolic BP variability. The authors demonstrated that day‐by‐day in‐hospital SBP variability can independently predict mortality and ARDS in COVID‐19 patients with hypertension. And high BPV might be correlated with severe inflammation and myocardial injury. Further studies are needed to clarify whether early reduction of BPV will improve the prognosis of these patients.     

Association of visit‐to‐visit blood pressure variability with the risk of all‐cause mortality and cardiovascular events in general population

The association between blood pressure variability (BPV) and the risk of all‐cause mortality and cardiovascular diseases (CVD) is not well understood. The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. In this study, resting blood pressure was measured at baseline and every 2 years from 2006 to 2007. BPV is mainly defined as the coefficient of variation (CV). Hazard ratio (HR), with 95% confidence intervals (CI) was calculated using Cox regression model. Among 52 387 participants, we identified 1817 who ended up with all‐cause death and 1198 with CVD. Each 4.68% increase in BPV was associated with a 13% increase in the risk of mortality (HR = 1.13, 95% CI = 1.09‐1.18) and a 7% increase in CVD (HR = 1.07, 95% CI = 1.02‐1.13), respectively. After adjustment of confounding factors, the HR of comparing participants in the highest versus lowest quartile of CV of systolic blood pressure (SBP) was 1.37 (1.19, 1.57) for all‐cause death, 1.18 (1.01, 1.39) for CVD. Similar results were also observed when BPV was measured by different parameters. We concluded that visit‐to‐visit BPV was associated with all‐cause death and cardiovascular and cerebrovascular events in Chinese general population.     

Optimal combinations of systolic and diastolic blood pressure in Korea: A nationwide population‐based cohort study

We investigated the optimal combinations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels for lowest mortality in participants not taking hypertensive medication at the study baseline using nationwide representative databases. Survival rates and hazard ratios (HRs) were calculated using Kaplan‐Meier curves and multivariable Cox regression analyses. The discriminatory ability for clinical outcomes was assessed by Harrell's C‐index analysis. A survival spline curve was presented, and Classification and Regression Tree (CART) analysis was performed. SBP ≥ 140 group and DBP ≥ 90 group had the highest risk of mortality. Within SBP < 120, the HR (95% CIs) for all‐cause mortality (ACM) was the lowest for DBP 70‐79. Within SBP 120‐139, the HR (95% CIs) for ACM was significantly lower for DBP 70‐79. Within SBP ≥ 140, the HR (95% CIs) for ACM was significantly lower for DBP 80‐89. Conversely, within SBP ≥ 140, DBP < 70 showed the highest risk for ACM. Similar relationships were observed when survival spline curves and CART analysis were used. The combination of SBP and DBP discriminated better than SBP or DBP alone for mortality. The effect of DBP on mortality varies according to the SBP range. It is more effective to evaluate the effect of SBP and DBP jointly for clinical outcomes.     

Ambulatory blood pressure and risk of new‐onset atrial fibrillation in treated hypertensive patients

The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new‐onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow‐up (mean 9.7 years, range 0.4–20 years), 116 events (new‐onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24‐h systolic BP were all significantly associated with increased risk of new‐onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11–1.35), 1.36 (1.21–1.53), 1.42 (1.29–1.57), and 1.42 (1.26–1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new‐onset AF, whereas daytime, nighttime, and 24‐h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97–1.23), 1.23 (1.10–1.39), 1.16 (1.03–1.31), and 1.22 (1.06–1.40), respectively. Daytime, nighttime, and 24‐h systolic BP are superior to clinic systolic BP in predicting new‐onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new‐onset AF.     

Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: A meta-analysis of cohort studies

This meta-analysis evaluated the potential association of a simultaneously measured inter-arm systolic blood pressure difference (IASBPD) and all-cause mortality and cardiovascular mortality. The Medline, Cochrane Library, Embase, and PubMed databases were searched through to April 14, 2023 for relevant literature. The outcomes were the associations of IASBPD with all-cause and cardiovascular mortality. Finally, 10 cohort studies that included 15 320 individuals were included. An IASBPD of ≥15 mm Hg was associated with increased all-cause mortality (pooled hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.02–1.61) but an IASBPD of ≥10 mm Hg was not (pooled HR 1.28, 95% CI 0.89–1.85). The pooled HR for cardiovascular mortality was 1.88 (95% CI 1.31–2.71) for an IASBPD of ≥10 mm Hg and 1.93 (95% CI 1.24–2.99) for an IASBPD of ≥15 mm Hg. Subgroup analysis showed that younger patients (HR 9.03, 95% CI 2.00–40.82, p = .004) with an IASBPD ≥15 mm Hg were at higher risk of cardiovascular mortality than older patients (HR 1.67, 95% CI 1.06–2.64, p = .03); the difference between groups was statistically significant (p = .04). In conclusions, our findings show that a simultaneously measured IASBPD ≥15 mm Hg predicts increased all-cause mortality and an IASBPD of ≥15 mm Hg or ≥10 mm Hg predicts increased cardiovascular mortality. An IASBPD ≥15 mm Hg appears to be more correlated with cardiovascular mortality in younger patients than in older patients.     

The relationship between blood pressure and mortality in the oldest old

OBJECTIVES: To explore the relationship between systolic and diastolic blood pressure and risk of 6-year, all-cause mortality in men and women age 65 to 84 versus those 85 and older. DESIGN: A population-based longitudinal study. SETTING: This study was conducted at four different sites: East Boston, Massachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmont, North Carolina. PARTICIPANTS: 12,802 community-dwelling persons age 65 and older. MEASUREMENTS: Baseline measurements collected include demographics, self-reported chronic medical conditions, blood pressure measurements, medications, health habits, and hospitalizations. RESULTS: Unadjusted actuarial survival analyses show that men age 65 to 84 years with systolic blood pressure < 130 mmHg have significantly lower mortality compared with those with systolic blood pressure > or = 180 mmHg (P < .0001). In contrast, men 85 and older with systolic blood pressure > or = 180 mmHg have significantly lower mortality compared with those with systolic blood pressure < 130 mmHg (P < .0001). In Cox proportional hazards analyses controlling for other predictors of survival, the hazard of death associated with each 10-mmHg increase in systolic blood pressure is positively associated among men age 65 to 84 years and negatively associated among men age 85 and older (Hazard ratio and 95% confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86, 0.99) for older men). Among women age 65 to 84, the hazard of death significantly increased with increase in systolic blood pressure (P < .0001), while there was no relationship between level of systolic blood pressure and survival in women 85 and older. Both men 65 to 84 years old and those 85 and older showed a negative relationship between diastolic blood pressure and all-cause mortality (Hazard ratio 0.93, 95% CI (0.88-0.97) for men age 65-84 years, and Hazard ratio 0.90, 95% CI 0.80-1.02 for men 85 and older). CONCLUSION: In men age 85 and older, higher systolic blood pressure is associated with better survival.     

24‐h ambulatory blood pressure variability and hypertensive nephropathy in Han Chinese hypertensive patients

Blood pressure (BP) is characterized by spontaneous oscillation over time, which is described as BP variability (BPV). The current study aimed to investigate whether short‐term BPV was correlated with hypertensive nephropathy in Han Chinese individuals with hypertension. A single‐center prospective cohort study of 300 Han Chinese participants with hypertension was conducted in Taiwan. Five different BPV parameters were derived from ambulatory BP monitoring (ABPM), including standard deviation (SD), weighted SD (wSD), coefficient of variation (CoV), successive variation (SV), and average real variability (ARV). Renal event was defined as > 50% reduction in baseline estimated glomerular filtration rate (eGFR). The average age of the participants was 63.5 years. The baseline eGFR was 84.5 mL/min/1.73 m². The participants were divided into two groups according to the wSD of systolic BP (SBP). Survival was assessed via a Kaplan‐Meier analysis. During the 4.2‐year follow‐up, the participants with the highest SBP wSD tertile had a greater number of renal events (6.0%) than their counterparts (0.5%) (log‐rank test, p = .007). The Cox proportional hazard regression model was used to assess the independent effects of BPV, and results showed that 24‐h SBP (HR = 1.105; 95% CI = 1.020–1.197, p = .015) and 24‐h DBP (HR = 1.162; 95% CI = 1.004–1.344, p = .044) were independently associated with renal events. However, BPV parameters were only associated with renal events univariately, but not after adjusting for baseline characteristics, 24‐h mean BP, and office BP. Therefore, the risk of hypertensive nephropathy was independently associated with 24‐h mean BP, but not with ambulatory BPV, in Han Chinese participants with hypertension.     

Early morning home blood pressure control among treated patients with controlled office blood pressure

Elevated morning blood pressure (BP) has a significantly increased risk of cardiovascular events, so morning BP is of substantial clinical importance for the management of hypertension. This study aimed to evaluate early morning BP control and its determines among treated patients with controlled office BP. From May to October 2018, 600 treated patients with office BP < 140/90 mm Hg were recruited from hypertension clinics. Morning BP was measured at home for 7 days. Morning home systolic blood pressure (SBP) increased by an average of 11.5 mm Hg and that morning home diastolic blood pressure (DBP) increased by an average of 5.6 mm Hg compared with office BP. Morning home SBP, DBP, and their moving average were more likely to be lower among patients with a office SBP < 120 mm Hg than among patients with a office SBP ranging from 120 to 129 mm Hg and from 130 to 139 mm Hg (P < .001). A total of 45% of patients had early morning BP < 135/85 mm Hg. The following factors were significantly correlated with morning BP control: male sex, age of <65 years, absence of habitual snoring, no drinking, adequate physical activity, no habit of high salt intake, office BP < 120/80 mm Hg, and combination of a calcium channel blocker (CCB) and angiotensin receptor blocker or angiotensin‐converting enzyme inhibitor (ARB/ACEI). Less than half of patients with controlled office BP had controlled morning BP and that positive changes may be related to an office BP < 120/80 mm Hg, combination of a CCB and ACEI/ARB and a series of lifestyle adjustments.     

原发性高血压合并脑微出血患者动态血压特征

目的 对原发性高血压（高血压）患者合并脑微出血的动态血压特征进行探讨.方法 选取80例高血压患者作为研究对象,并将其中有脑微出血的42例患者列为观察组,未合并有脑微出血的38例患者列为对照组.对两组患者的动态血压值进行观察和比较.结果 两组收缩压、舒张压比较,差异无统计学意义（P＞0.05）.两组的随测血压值均比24动态血压监测（ABMP）值高,差异有统计学意义（P＜0.05）.观察组的收缩压夜间下降率、舒张压夜间下降率均低于对照组,差异有统计学意义（P＜0.05）.结论 高血压患者的血压在夜间降低是引发脑微出血相关因素,因此在临床治疗期间,需对血压的动态节律变化加以注意.     

Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study

To evaluate the association between blood pressure variability (BPV) and mortality in the elderly, all blood pressure measurements recorded in a cohort of individuals 65 years and older were collected and the association between BPV coefficient of variation (BPV divided by mean arterial pressure) was calculated. Mortality during a 10‐year period was compared between BPV coefficient of variation quartiles. Overall, 39 502 individuals 65 years and older were included in the analysis, of which 31 737 (80.3%) were hypertensive; 12 817 (32.4%) individuals died during the study period. Mortality was lower in the second and third blood pressure quartiles compared with the first quartile in both the normotensive and hypertensive groups. In both normotensive and hypertensive individuals, mortality was higher in the fourth quartile, but it was more pronounced in normotensive individuals (odds ratio, 1.18; 95% confidence interval, 1.06–1.31 in hypertensive individuals vs odds ratio, 1.27; 95% confidence interval, 1.17–1.37 in normotensive individuals). High and low BPV are associated with mortality in both hypertensive and normotensive elders.