Impact of lower achieved blood pressure on outcomes in hypertensive patients

Journal of Hypertension
Peter M OkinRichard B Devereux

Abstract

Hypertensive patients with ECG left-ventricular hypertrophy (LVH) are at increased risk of cardiovascular morbidity and mortality, and regression of ECG LVH is associated with improved cardiovascular outcomes. Although tighter control of systolic blood pressure (SBP) has been associated with a lower rate of ECG LVH, whether tighter vs. standard control of SBP is associated with greater reduction of cardiovascular risk is unclear. Risk of stroke, myocardial infarction (MI), cardiovascular death, the composite endpoint of these events and all-cause mortality were examined in relation to in-treatment achieved SBP in 9193 hypertensive patients with ECG LVH randomly assigned to losartan or atenolol-based treatment. Patients with in-treatment SBP 130 mmHg or less (lowest quintile at last measurement) and SBP between 131 and 141 mmHg were compared with patients with in-treatment SBP at least 142 mmHg (median SBP at last measurement). In univariate analyses, compared with in-treatment SBP at least 142 mmHg, in-treatment SBP between 131 and 141 mmHg entered as a time-varying covariate identified patients with significantly lower risk of all events. In contrast, patients with SBP 130 mmHg or less had less reduction in MI, stroke and comp...Continue Reading

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