(This group may have fewer BPs recorded in primary care because of greater specialist input in secondary care.) Median SBP was categorized as less than 125 mmHg, 125 to 134 mmHg, 135 to 144 mmHg, 145 to 154 mmHg, 155 to 164 mmHg, 165 to 174 mmHg, 175 to 184 mmHg, and 185 mmHg and greater. Covariates Sex, age at beginning of follow\up, quintile of 2010 English Index of Multiple Deprivation for England (based on GP’s postcode, as a proxy for socioeconomic status), and smoking status (from recorded GP Read terms, classified as current or recent smoker, exsmoker, and never smoker over the 10 years before study entry) were adjusted for in the statistical modelling. Analysis Because of Incomplete Data on Blood Pressure Table S7. Number Needed to Treat (NNT)\Based Estimates of Mortality or Incident Disease According to Systolic Blood Pressure (SBP; Reference 145C154 mmHg) Table S8. Sensitivity Analyses of Effect of Incident Cancer on All\Cause Mortality According to Systolic Blood Pressure (SBP; Reference 145C154 mmHg) JGS-65-995-s001.docx (440K) GUID:?A85CA433-5C86-415D-9232-C822B4121378 Abstract Objectives To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice. Design Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension. Setting Primary care practices in England (Clinical Practice Research Datalink). Participants Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end\stage renal failure at baseline. Measurements Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10\mmHg increments from less than 125 to 185 mmHg or more (reference 145C154 mmHg). Results Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19C1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short\ and long\term follow\up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group. Conclusion In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care. (ICD\10) codes in HES10 were used to identify individuals with hypertension. Individuals with comorbidities that require specialized treatment or might introduce confounding (reverse causation with the comorbidity Tasquinimod reducing BP) were excluded. Diagnoses excluded at baseline were dementia, cancer, stroke, heart failure, coronary heart disease, and end\stage renal failure (diagnosis of chronic kidney disease Stage 5 from CPRD or HES or dialysis code in CPRD, HES, or Office of Population Censuses and Surveys Classification of Rabbit Polyclonal to PEA-15 (phospho-Ser104) Interventions and Procedures version 4) (Figure S1)10, 11. Sensitivity analyses on the effect of excluding individuals with diabetes mellitus or chronic obstructive pulmonary disease (conditions that might particularly affect management of hypertension in their late stages) on all\cause mortality did not significantly alter results, so such individuals were not excluded (Table S2). BP Data BP was measured during routine general practitioner (GP) visits and recorded by the GP, nurse, or other practice staff,8 normally in a sitting position at rest.4 Measurements were excluded if they did not record SBP and diastolic BP (DBP). Individual measurements with extreme values ( 0.15 Tasquinimod and 99.85 centile) (SBP: 85 mmHg and 224 mmHg; DBP: 46 mmHg and 120 mmHg) were excluded. The median of BP measurements recorded during the lead\in period were used to estimate stable treated baseline SBP and DBP; the median was used to avoid biases from extreme measures during acute clinical events. The average number of BP measurements according to SBP category varied from 7.2 for less than 125 mmHg to 13.4 for 165 to 174 mmHg (Table S3); 15,265 individuals diagnosed with and treated for hypertension had fewer than three BP measurements (Figure S1). This excluded group had a higher prevalence of dementia and heart failure at baseline, which would have triggered exclusion anyway. (This group may have fewer BPs recorded in primary care because of greater specialist input in secondary care.) Median SBP was categorized as less than 125 mmHg, 125 to 134 mmHg, 135 to 144 mmHg, 145 to 154 mmHg, 155 to 164 mmHg, 165 to 174 mmHg, 175 to 184 mmHg, and 185 mmHg and greater. Covariates Sex, age at beginning of follow\up, quintile of 2010 English Index of Multiple Deprivation for England (based on GP’s postcode, as a proxy for socioeconomic status), and smoking status (from recorded GP Read terms, classified as current or recent smoker, exsmoker, and never smoker over the 10 years before study entry) were adjusted Tasquinimod for in the.
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