Circulation, Vol 90, 225-233, Copyright © 1994 by American Heart Association
CJ Bulpitt, AJ Palmer, AE Fletcher, DG Beevers, EC Coles, JG Ledingham, PW O'Riordan, JC Petrie, BE Rajagopalan and J Webster
BACKGROUND: We wished to determine the range of treated systolic (SBP) and
diastolic blood pressure (DBP) associated with the best survival in
hypertensive patients. METHODS AND RESULTS: We conducted a cohort study of
patients enrolled in the DoH Hypertension Care Computer Project. Five
specialist hypertension clinics (95% of patients) and general practitioners
(5%) followed 6214 patients (3070 men and 3144 women) with an average age
of 52 years for a mean of 107 months. Total, cardiovascular, ischemic heart
disease, (IHD) and stroke mortality were the outcome measures. Age-adjusted
relative hazard rates were calculated giving the effect on mortality of
systolic or diastolic pressure being higher by 1 mm Hg. In men the optimal
level of SBP for all four measures of mortality was the lowest pressure
range observed, 92 to 133 mm Hg (median 127). For women the treated SBP
range of 96 to 148 mm Hg (median 137) was associated with a low total
mortality and also with low to moderate rates for IHD and stroke mortality.
Relative hazard rates (P < .001) for IHD mortality were 1.010 for men
and 1.013 for women and for stroke mortality were 1.018 and 1.021,
respectively. The results were similar in men under and over the age of 60.
SBP and DBP tended to be more important in younger than older women. For
treated DBP in men, a pressure of 55 to 94 mm Hg (median 87) was associated
with a low total mortality. The lowest stroke mortality in men was observed
for a DBP range of 55 to 83 mm Hg (median 80) but with a tendency for an
increase in IHD mortality. For women DBP < 95 mm Hg (range 55 to 94,
median 87) also was associated with a low total mortality. IHD mortality in
women was not closely related to treated DBP, relative hazard rate = 1.003,
[95% confidence index (CI); 0.990,1.017] but the relative hazard rate for
men was 1.011, (95% CI; 1.000, 1.022). The relative hazard rates for
treated DBP and stroke were high at 1.035 and 1.028 for men and women,
respectively (P < .001). IHD mortality increased in the one third of
patients with the greatest fall in DBP on treatment, provided they were not
initially in the one-third group with highest untreated DBP. CONCLUSIONS:
The best overall survival was associated with a treated SBP of < 134 mm
Hg in men and < 149 mm Hg in women and a treated DBP of < 95 mm Hg.
ARTICLES
Optimal blood pressure control in treated hypertensive patients. Report from the Department of Health Hypertension Care Computing Project (DHCCP)
Division of Geriatric Medicine, Royal Postgraduate Medical School, London, United Kingdom.
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