Cargando…

Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension

BACKGROUND: Accumulating evidence indicates that reducing systolic blood pressure (BP) to <140 mm Hg improves health outcomes; however, an optimal level has not yet been determined. Many population studies or post hoc analyses suggest a target systolic BP between 120 and 140 mm Hg with increased...

Descripción completa

Detalles Bibliográficos
Autores principales: Doumas, Michael, Tsioufis, Costas, Fletcher, Ross, Amdur, Richard, Faselis, Charles, Papademetriou, Vasilios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721788/
https://www.ncbi.nlm.nih.gov/pubmed/29101118
http://dx.doi.org/10.1161/JAHA.117.007131
_version_ 1783284881743151104
author Doumas, Michael
Tsioufis, Costas
Fletcher, Ross
Amdur, Richard
Faselis, Charles
Papademetriou, Vasilios
author_facet Doumas, Michael
Tsioufis, Costas
Fletcher, Ross
Amdur, Richard
Faselis, Charles
Papademetriou, Vasilios
author_sort Doumas, Michael
collection PubMed
description BACKGROUND: Accumulating evidence indicates that reducing systolic blood pressure (BP) to <140 mm Hg improves health outcomes; however, an optimal level has not yet been determined. Many population studies or post hoc analyses suggest a target systolic BP between 120 and 140 mm Hg with increased risk above and below that range. We tested the hypothesis that consistent control of systolic BP between 120 and 140 mm Hg—time in therapeutic range—is a strong determinant of all‐cause mortality among US veterans. METHODS AND RESULTS: A total of 689 051 individuals from 15 Veterans Administration Medical Centers were followed over a 10‐year period. Participants were classified as hypertensive, intermediate hypertensive, and normotensive according to the number of elevated BP recordings (>3, 1 or 2, and none, respectively). Time within, above, or below therapeutic range (120–140 mm Hg) was considered in quartiles and related to all‐cause mortality. The study population consisted of 54% hypertensive, 19.9% intermediate, and 26.1% normotensive participants; the corresponding mortality rates for the 3 groups were 11.5%, 8%, and 1.9%, respectively (P<0.0001 for all comparisons). Mortality rates for hypertensive participants with BP consistently within, above, or below the therapeutic range were 6.5%, 21.9%, and 33.1%, respectively (P<0.0001 for all comparisons). Mortality rates in hypertensive participants increased from 6.5% in the most consistently controlled quartile (>75%) to 8.9%, 15.6%, and 23.5% towards the less consistently controlled quartiles (50–75%, 25–50%, and <25%, respectively; P<0.0001 for all comparisons). CONCLUSIONS: An inverse and gradual association between time in therapeutic range and all‐cause mortality was observed in this large veteran cohort. Consistency of BP control over time is a strong determinant of all‐cause mortality, and consistency of BP control should be monitored in everyday clinical practice.
format Online
Article
Text
id pubmed-5721788
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-57217882017-12-12 Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension Doumas, Michael Tsioufis, Costas Fletcher, Ross Amdur, Richard Faselis, Charles Papademetriou, Vasilios J Am Heart Assoc Original Research BACKGROUND: Accumulating evidence indicates that reducing systolic blood pressure (BP) to <140 mm Hg improves health outcomes; however, an optimal level has not yet been determined. Many population studies or post hoc analyses suggest a target systolic BP between 120 and 140 mm Hg with increased risk above and below that range. We tested the hypothesis that consistent control of systolic BP between 120 and 140 mm Hg—time in therapeutic range—is a strong determinant of all‐cause mortality among US veterans. METHODS AND RESULTS: A total of 689 051 individuals from 15 Veterans Administration Medical Centers were followed over a 10‐year period. Participants were classified as hypertensive, intermediate hypertensive, and normotensive according to the number of elevated BP recordings (>3, 1 or 2, and none, respectively). Time within, above, or below therapeutic range (120–140 mm Hg) was considered in quartiles and related to all‐cause mortality. The study population consisted of 54% hypertensive, 19.9% intermediate, and 26.1% normotensive participants; the corresponding mortality rates for the 3 groups were 11.5%, 8%, and 1.9%, respectively (P<0.0001 for all comparisons). Mortality rates for hypertensive participants with BP consistently within, above, or below the therapeutic range were 6.5%, 21.9%, and 33.1%, respectively (P<0.0001 for all comparisons). Mortality rates in hypertensive participants increased from 6.5% in the most consistently controlled quartile (>75%) to 8.9%, 15.6%, and 23.5% towards the less consistently controlled quartiles (50–75%, 25–50%, and <25%, respectively; P<0.0001 for all comparisons). CONCLUSIONS: An inverse and gradual association between time in therapeutic range and all‐cause mortality was observed in this large veteran cohort. Consistency of BP control over time is a strong determinant of all‐cause mortality, and consistency of BP control should be monitored in everyday clinical practice. John Wiley and Sons Inc. 2017-11-03 /pmc/articles/PMC5721788/ /pubmed/29101118 http://dx.doi.org/10.1161/JAHA.117.007131 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Doumas, Michael
Tsioufis, Costas
Fletcher, Ross
Amdur, Richard
Faselis, Charles
Papademetriou, Vasilios
Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title_full Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title_fullStr Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title_full_unstemmed Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title_short Time in Therapeutic Range, as a Determinant of All‐Cause Mortality in Patients With Hypertension
title_sort time in therapeutic range, as a determinant of all‐cause mortality in patients with hypertension
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721788/
https://www.ncbi.nlm.nih.gov/pubmed/29101118
http://dx.doi.org/10.1161/JAHA.117.007131
work_keys_str_mv AT doumasmichael timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension
AT tsioufiscostas timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension
AT fletcherross timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension
AT amdurrichard timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension
AT faselischarles timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension
AT papademetriouvasilios timeintherapeuticrangeasadeterminantofallcausemortalityinpatientswithhypertension