Open AccessLow Blood Pressure Is Associated With Greater Risk for Cardiovascular Events in Treated Adults With and Without Apparent Treatment‐Resistant Hypertension
Author(s) -
Egan Brent M.,
Kai Bo,
Wagner C. Shaun,
Fleming Douglas O.,
Henderson Joseph H.,
Chandler Archie H.,
Sinopoli Angelo
Publication year - 2017
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12904
Subject(s) - hazard ratio , medicine , confidence interval , blood pressure , gastroenterology
Apparent treatment‐resistant hypertension (a TRH ) may confound the reported relationship between low blood pressure ( BP ) and increased cardiovascular disease ( CVD ) in treated hypertensive patients. Incident CVD was assessed in treated hypertensive patients with and without a TRH ( BP ≥140 and/or ≥90 mm Hg on ≥3 medications or <140/<90 mm Hg on ≥4 BP medications) at three BP levels: 1: <120 and/or <70 mm Hg and <140/<90 mm Hg; 2: 120–139/70–89 mm Hg; and 3: ≥140 and/or ≥90 mm Hg. Electronic health data were matched to emergency and hospital claims for incident CVD in 118 356 treated hypertensive patients. In adults with and without a TRH , respectively, CVD was greater in level 1 versus level 2 (multivariable hazard ratio, 1.88 [95% confidence interval [CI], 1.70–2.07]; 1.71 [95% CI, 1.59–1.84]), intermediate in level 1 versus level 3 (hazard ratio, 1.32 [95% CI, 1.21–1.44]; 0.99, [95% CI, 0.92–1.07]), and lowest in level 2 versus level 3 (hazard ratio, 0.70 [95% CI, 0.65–0.76]; 0.58, [95% CI, 0.54–0.62]). Low treated BP was associated with more CVD than less stringent BP control irrespective of a TRH .