John J Sim1, Hui Zhou2, Simran Bhandari3, Rong Wei2, Jeff W Brettler4, Jocelyn Tran-Nguyen4, Joel Handler4, Daichi Shimbo5, Steven J Jacobsen2, Kristi Reynolds2. 1. Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: john.j.sim@kp.org. 2. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California. 3. Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. 4. Regional Hypertension Program, Kaiser Permanente Southern California, Pasadena, California. 5. Department of Medicine, Columbia University Medical Center, New York, New York.
Abstract
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.
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 hypertensivepatients, 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.
Authors: Amy Z Sun; Yu-Hsiang Shu; Teresa N Harrison; Aviv Hever; Steven J Jacobsen; Michelle M O'Shaughnessy; John J Sim Journal: Perm J Date: 2020-02-07
Authors: Eric A Lee; Jeffrey W Brettler; Michael H Kanter; Steven G Steinberg; Peter Khang; Christopher C Distasio; John Martin; Mark Dreskin; Nolan H Thompson; Timothy M Cotter; Kim Thai; Lyn Yasumura; Nancy E Gibbs Journal: Perm J Date: 2019-12-11
Authors: Cheng-Wei Huang; Bonnie H Li; Kristi Reynolds; Steven J Jacobsen; Connie M Rhee; John J Sim Journal: Medicine (Baltimore) Date: 2020-04 Impact factor: 1.817