Impact of blood pressure control level on all-cause mortality and CVD mortality in patients with hypertension and its comorbidities: A prospective cohort study in Southwest China

Abstract

ABSTRACTBackgroundBlood pressure (BP) control levels may be associated with the risk of all-cause mortality and CVD mortality. The goal of this study was to explore the association of BP control levels with the risk of all-cause mortality and CVD mortality in adults in Guizhou, China.MethodsA 13-year prospective cohort study of 1,905 hypertension patients adults aged 18 years or older was conducted in Guizhou, southwest China from 2010 to 2023. Information of participants death were collected, cause of death was coded according to ICD-10 and codes I00-I99 was categorized as CVD-related deaths. Cox proportional hazard regression was used to examine the associations of BP control levels with all-cause mortality and CVD mortality.Results134 deaths occurred during a median follow-up of 11.72 years. The multivariable cox hazard regression models showed that compared with SBP≥140 mmHg and DBP≥90 mmHg group, participants with SBP <120 mmHg and DBP <80 mmHg, they had the lowest risk of all-cause mortality (HR=0.265, 95%CI:0.111,0.630) and the lower risk of CVD death (HR=0.274, 95%CI:0.092,0.814). Associations between BP control levels with all-cause mortality and CVD mortality were suggested to be even stronger among aged ≥65 years (P<0.05), but ideal BP levels were not significantly associated with CVD mortality in participants with comorbidity (P>0.05).ConclusionOptimal BP control levels(<120/80mmHg) is effective in reducing overall mortality and cardiovascular disease (CVD) mortality, even among older adults. however, for hypertension with comorbidities, mere BP control alone may not suffice, consideration should also be given to the treatment of other coexisting conditions.NOVELTY AND RELEVANCEWhat Is New?To our knowledge, few studies have investigated the relationship between the levels of blood pressure control in hypertensive patients and all-cause mortality in the Chinese population. Furthermore, there exists divergent viewpoints regarding the extent of blood pressure management in geriatric patients diagnosed with hypertension.In this study, we used data from a prospective cohort study in Southwest China to investigate whether the level of blood pressure control of hypertension patients was associated with all-cause mortality and cardiovascular disease (CVD) death and test whether those associations were modified by age or comorbidity factors.What Is Relevant?Using data from a prospective cohort study in Southwest China, we found that maintaining optimal blood pressure control levels (<120/80mmHg) was found to significantly reduce overall mortality and cardiovascular disease (CVD) mortality, even among elderly individuals.Clinical/Pathophysiological Implications?The association between blood pressure and all-cause mortality serves as a guide for the management and control of hypertension in patients.