Introduction
With the growing emphasis on intensive blood pressure control, the potential for overtreatment
and treatment-related adverse outcomes has become an area of interest. A large representative
population within a real-world clinical environment with successful hypertension control
rates was used to evaluate serious falls and syncope in people with low-treated systolic
blood pressure (SBP).
Methods
A cross-sectional study among medically treated hypertensive individuals within the
Kaiser Permanente Southern California health system (2014–2015) was performed. Serious
fall injuries and syncope were identified using ICD codes based on emergency department
and hospitalization diagnoses. SBPs in a 1-year window were used to compare serious
falls and syncope among individuals with SBP <110 mmHg vs ≥110 mmHg. Logistic regression
was used to evaluate the association between low minimum and mean SBP and serious
falls/syncope after adjustment for demographics, comorbidities, and medications.
Results
In 477,516 treated hypertensive individuals, the mean age was 65 (SD=13) years and
the mean SBP was 129 (SD=10) mmHg, with 27% having a minimum SBP <110 mmHg and 3%
having mean SBP <110 mmHg. A total of 15,419 (3.2%) individuals experienced a serious
fall or syncope or both during the observation window (5.7% among minimum SBP <110
mmHg and 5.4% among mean SBP <110 mmHg). The multivariable ORs for serious falls/syncope
were 2.18 (95% CI=2.11, 2.25) for minimum SBP <110 mmHg and 1.54 (95%CI=1.43, 1.66)
for mean SBP <110 mmHg compared with SBP ≥110 mmHg.
Conclusions
Among treated hypertensive patients, both minimum and mean SBP less than 110 mmHg
were associated with serious falls and syncope. Low treatment-related blood pressures
deserve consideration given the emphasis on intensive blood pressure control.
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Article info
Publication history
Published online: August 23, 2018
Identification
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
