Optimized BP Thresholds According to Risks

A Korean population-based cohort study suggests that intensive blood pressure (BP) control is appropriate for reducing all-cause mortality in addition to cardiorenal risk in higher- rather than lower-risk patients. A total of 1 402 975 adults aged 40 to 79 years who had no known cardiorenal disease were included from 2002 to 2015 and 2006 to 2017. During the study periods, 225 103 of 487 412 participants (54.0% male; median age 50 years) in the primary cohort and 360 503 of 915 563 participants (50.1% male; median age 52 years) in the secondary cohort received antihypertensive treatment. In total, 28 411 of 51 292 cardiorenal incidents and 33 102 of 72 500 deaths were noted in ever-treated participants. The absolute increase in cardiorenal and mortality risk associated with inadequately treated BP was greater in participants with multiple risk factors (including hypertension, diabetes, hyperlipidemia, proteinuria, and smoking) than in those with 1 or 0 risk factors. The hazard ratios (HR) for critical cardiorenal events increased as the treated systolic BP increased to more than 130 to 140 mm Hg. Compared with BP of 120 to 129 mm Hg, the HR for all-cause mortality was 1.21, 1.04, 1.12, 1.21, and 1.46, respectively, for patients with 3 or more risk factors and treated systolic BP within the range of 110 to 119, 130 to 139, 140 to 149, 150 to 159, and 160 mm Hg or greater. For participants with 1 or 0 risk factors, the HR was 1.14, 0.97, 1.00, 1.06, and 1.26, respectively, for treated systolic BP within the range of 110 to 119, 130 to 139, 140 to 149, 150 to 159, and 160 mm Hg or greater. However, when categorized using cardiovascular risk calculators, there was no consistent trend in mortality thresholds of BP across the risk score categories. The findings suggest that BP targets should be individualized and that intensive BP control should be considered for higher- rather than lower-risk patients. Source: https://jamanetwork.com/