Increased mortality in patients with delayed BP control after first diagnosis
The prognostic value of blood pressure control delay in newly diagnosed hypertensive patientsLiterature - Martın-Fernandez M, Vinyolesa E, Real J, et al. - J Hypertension 2018;36: published online ahead of print
Introduction and methods
Data from small sub-studies suggest that a delay in blood pressure (BP) management after initial diagnosis is associated with an increased cardiovascular (CV) risk. Evidence from studies specifically designed to study this relation is lacking to date [1-3].
In this retrospective cohort study, the effect of delayed BP control in patients with newly diagnosed hypertension on CV morbidity and mortality was evaluated in everyday clinical practice. Moreover, the time needed to reach good BP control in individuals >60 years with a recent diagnosis of hypertension was assessed, and the variables associated with delays were identified.
For this purpose, data from electronic clinical records were collected for 2007 until 2012, including patients with hypertension, who were not receiving antihypertensive medication and had no CV disease at baseline. A total of 18,721 patients were eligible for the analysis, with a mean age of 71.6 years, out of whom 57% were women. The main variables of interest were the time between diagnosis and control of BP (diagnostic-control time, D-C), defined as the first registered measurement of BP <140/90 mm Hg after diagnosis, as well as the appearance of the first CV event or all-cause death.
- The distribution of D-C times in tertiles was ≤29 days, 30–124 days, and ≥125 days. The median D-C time was 49 days (interquartile range: 21-232).
- Higher levels of BP, increased BMI, and male gender were independently associated with longer D-C times (≥125 days).
- During a mean follow-up period of 5.4 years, all-cause death occurred in 641 out of 6,426 patients in the first D-C time tertile (10.0%), in 615 our of 6,054 in the second tertile and in 751 out of 6,241 patients in the third D-C time tertile (12.0%; P<0.01 of third tertile vs first plus second tertiles).
- Male sex (HR: 0.55, 95%CI: 0.494-1.612 for women), age (HR: 1.11, 95%CI: 1.104-1.118), smoking (HR: 1.815, 95%CI: 1.512-2.178), diabetes mellitus (HR: 1.544, 95%CI: 1.355-1.760), and a D-C time of at least 125 (HR: 1.146, 95%CI: 1.028-1.278) were significantly and independently associated with all-cause mortality.
- Higher diastolic BP (HR: 0.993, 95%CI: 0.988-0.999) and hypercholesterolemia (HR:0.726, 95%CI: 0.629-0.838) were associated with lower all-cause mortality.
Delaying BP control in newly diagnosed patients with hypertension is independently associated with higher all-cause mortality. Such a delay is a modifiable risk factor, which should be taken into account in clinical practice. Moreover, this study showed that male sex, age, diabetes, smoking and lower DBP were independently associated with all-cause mortality.