ArticleHypertension research : official journal of the Japanese Society of Hypertension2024
Low on-treatment blood pressure and cardiovascular events in patients without elevated risk: a nationwide cohort study.
Article in Hypertension research : official journal of the Japanese Society of Hypertension, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis.Journal of internal medicine · 2025Pooled it
- New-Onset Atrial Fibrillation and Accelerated Kidney Function Decline in Working-Age Adults.JAMA network open · 2026Article
- Current hypertension epidemiology and contemporary approaches using the "Real-World Evidence Cycle" framework.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Review
- Time in Target Range of Systolic Blood Pressure and Cardiovascular Disease in Patients with Chronic Kidney Disease: A Korean Nationwide Cohort Study.American journal of nephrology · 2026Article
- The importance of the time in target range (TTR) of glucose and blood pressure.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Incidence of the Triple Whammy Phenomenon among Cardiovascular diseases patients in Saudi Arabia and awareness among healthcare professionals.Frontiers in nephrology · 2025Article
- Usefulness and caveats of real-world data for research on hypertension and its association with cardiovascular or renal disease in Japan.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Review
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Authors and funding
3 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
Insufficient blood pressure control among patients with hypertension without elevated risk is a global concern, suggesting the need for treatment optimization. However, the potential harm of excessive blood pressure lowering among these patients is understudied. This study addressed this evidence gap by using nationally representative public health insurer database covering 30 million working-age population. Patients who were continuously using antihypertensive drugs with 10-year cardiovascular risk <10% were identified. They were categorized by on-treatment systolic and diastolic blood pressures. The primary outcome was a composite of myocardial infarction, stroke, heart failure hospitalization, and peripheral artery disease. Of 920,533 participants (mean age, 57.3 years; female, 48.3%; mean follow-up, 2.75 years), the adjusted hazard ratios for systolic blood pressure of <110, 110-119, 120-129 (reference), 130-139, 140-149, 150-159, and ≥160 mmHg were 1.05 (95% confidence interval: 0.99-1.12), 0.97 (0.93-1.02), 1 (reference), 1.05 (1.01-1.09), 1.15 (1.11-1.20), 1.30 (1.23-1.37), and 1.76 (1.66-1.86), respectively; and for diastolic blood pressure of <60, 60-69, 70-79 (reference), 80-89, 90-99, and ≥100 mmHg were 1.25 (1.14-1.38), 0.99 (0.95-1.04), 1 (reference), 1.00 (0.96-1.03), 1.13 (1.09-1.18), and 1.66 (1.58-1.76), respectively. Among low-risk patients with hypertension, diastolic blood pressure <60 mmHg was associated with increased cardiovascular events, while systolic blood pressure <110 mmHg was not. Compared to previous investigations in high-risk patients, the potential harm of excessive blood pressure lowering was less pronounced in low-risk patients with hypertension. The association between low on-treatment blood pressure and cardiovascular events has been understudied in low-risk patients with hypertension. In our study with nationally representative working-age adults from general population with hypertension without elevated risk, increased risk of cardiovascular events was observed in diastolic blood pressure of <60 mmHg, but not in systolic blood pressure of <110 mmHg. Those results contrasted with previous investigations in high-risk patients where the risk of low on-treatment blood pressure was more pronounced.
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