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Survival with Treated and Well-Controlled Blood Pressure: Findings from a Prospective Cohort Study.

Lawlor, DA; Kim, L; Morris, R; Amuzu, A; Whincup, P; Ebrahim, S (2011) Survival with Treated and Well-Controlled Blood Pressure: Findings from a Prospective Cohort Study. PLOS ONE, 6 (4). e17792. ISSN 1932-6203
SGUL Authors: Whincup, Peter Hynes

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AIM: To compare survival and incident cardiovascular disease between normotensive, untreated hypertensive, treated and poorly-controlled hypertensive and treated and well-controlled hypertensive adults. METHODS AND RESULTS: Data from the British Regional Heart Study (men) and British Women's Heart and Health Study (women) were used (N = 6476). Blood pressure and treatment were assessed at baseline (1998-2001) when participants were aged 60-79 years and participants were followed up for a median of 8 years. Date and cause of death were obtained from death certificates and non-fatal cardiovascular disease events were obtained from repeat detailed medical record reviews. Of the whole cohort 52% of women and 49% of men had untreated hypertension and a further 22% and 18%, respectively, had poorly treated hypertension. Just 3% of women and 4% of men had treated and well controlled hypertension and 23% and 29%, respectively, were normotensive. Compared to normotensive individuals, incident cardiovascular disease (fatal and non-fatal) was increased in those with poorly-controlled hypertension (Hazard Ratio (HR): 1.88; 95%CI: 1.53, 2.30), those with untreated hypertension (HR 1.46; 95%CI 1.22, 1.75) and those who were well-controlled hypertension (HR 1.38; 95%CI 0.94, 2.03). Adjustment for baseline differences in mean blood pressure between the groups resulted in attenuation of the increased risk in the poorly-controlled (1.52 (1.18, 1.97) and untreated groups (1.21 (0.97, 1.52), but did not change the association in the well-controlled group. All-cause mortality was also increased in all three hypertension groups but estimates were imprecise with wide confidence intervals. CONCLUSIONS: Half of women and men aged 60-79 in Britain had untreated hypertension and only a very small proportion of those with diagnosed and treated hypertension were well controlled. Those with hypertension, irrespective of whether this was treated and controlled or not, were at greater risk of future cardiovascular disease than those who are normotensive.

Item Type: Article
Additional Information: ©2011 Lawlor et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Aged, Blood Pressure, Female, Follow-Up Studies, Great Britain, Humans, Hypertension, Male, Proportional Hazards Models, Prospective Studies, Science & Technology, Multidisciplinary Sciences, Science & Technology - Other Topics, CORONARY-HEART-DISEASE, BRITISH WOMENS HEART, RISK-FACTORS, HEALTH, HYPERTENSION, QUALITY, BURDEN, STROKE, TRIALS, CARE
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: PLOS ONE
ISSN: 1932-6203
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13 April 2011Published
Web of Science ID: WOS:000289458800006
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