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Overtreatment, undertreatment of hypertension raises risk for mortality and renal disease
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Patients with hypertension who had systolic BP within the range of 130 to 139 mm Hg and diastolic BP within the range of 60 to 79 mm Hg had a lower risk for end-stage renal disease and mortality compared with patients with BP levels outside of those ranges, either above or below, according to a new report.
Researchers evaluated data collected from 398,418 adults treated for hypertension within the Kaiser Permanente Southern California health system from January 2006 to Dec. 31, 2010. The mean age of the cohort was 64 years and 55% were women. Mean BP was 131/73 mm Hg.
The primary endpoint of the study was a composite of mortality and end-stage renal disease, defined as need for dialysis or renal transplantation. During a mean follow-up of 4 years, the primary endpoint occurred in 7.3% of the patients, including death in 6.3% and end-stage renal disease in 1.2%.
Compared with patients with systolic BP between 130 and 139 mm Hg, those who achieved BP higher and lower than that range had an increased risk for mortality and end-stage renal disease; the highest rates were observed among patients who achieved the lowest (22.9%) and highest (15.7%) levels of systolic BP. The researchers calculated adjusted HRs of 4.1 (95% CI, 3.87-4.33) for systolic BP <110 mm Hg and 1.8 (95% CI, 1.7-1.9) for 110 to 119 mm Hg, and HRs of 4.9 (95% CI; 4.4-5.5) for BP ≥170 mm Hg and 3.3 (95% CI, 3-3.6) for 160 to 169 mm Hg. When systolic BP was modeled as a continuous variable, the nadir systolic and diastolic BP for the lowest risk was 137 mm Hg and 71 mm Hg, according to the results.
Stratification according to diabetes status yielded similar results for mortality and end-stage renal disease risk among patients with diabetes. However, results showed lower nadir systolic and diastolic BP at 131 mm Hg and 69 mm Hg. A higher nadir was observed among adults with diabetes aged 70 years and older (140 mm Hg and 70 mm Hg).
“Physicians have often emphasized the need to bring a patient’s BP down as low as possible for the best outcomes,” John J. Sim, MD, from the division of nephrology and hypertension at Kaiser Permanente Los Angeles Medical Center, said in a press release. “However, the findings of our study suggest that treating patients with high BP too aggressively may actually lead to poor health outcomes.”
Disclosure: Kaiser Permanente Southern California Regional Research supported the study. One researcher reports receiving research grants from Keryx Pharmaceuticals, Questcor Pharmaceuticals and Sanofi Aventis.
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