Among patients with hypertension (HTN), elevated systolic blood pressure (SBP) is associated with the highest risk for cardiovascular events, although once SBP is below 140,lowering it below 120 does not further reduce the risk of cardiovascular events, according to a study published June 16 in JAMA Internal Medicine.

Carlos J. Rodriguez, M.D., from Wake Forest University in Winston-Salem, N.C., and colleagues analyzed data from the Atherosclerosis Risk in Communities Study for 4,480 participants with HTN but without prevalent CV disease at baseline (1987 to 1989). SBP measurements were taken at baseline and at three triennial visits, and SBP was categorized as elevated (≥140 mm Hg), standard (120 to 39 mm Hg), and low (<120 mm Hg).

The researchers found that a total of 1,622 incident CV events occurred over a median follow-up of 21.8 years. There was a significantly higher rate of incident CV events among participants with elevated SBP compared to those in the low BP group (adjusted hazard ratio [HR], 1.46; 95 percent confidence interval [CI], 1.26-1.69). For those in the standard versus low SBP group, there was no difference in incident CV event-free survival (adjusted HR, 1.00; 95 percent CI, 0.85 to 1.17). These results were not affected by adjustment for BP medication use or diastolic BP.

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“Among patients with HTN, having an elevated SBP carries the highest risk for cardiovascular events, but in this categorical analysis, once SBP was below 140mmHg, an SBP lower than 120mmHg did not appear to lessen the risk of incident CV events,” the authors write.

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