Abstract 15973: The Association Between Blood Pressure Control and Outcomes Among Black Participants in the Jackson Heart Study

Abstract

Introduction: The 2014 hypertension (HTN) guidelines liberalized blood pressure (BP) goals for people ≥60 years. Hypothesis: Increased systolic and diastolic blood pressure (SBP/DBP) will be associated with a higher risk of mortality and heart failure hospitalization (HFH) across all age groups. Methods: We used age-adjusted Kaplan-Meier estimates to calculate the cumulative incidence of mortality and HFH across SBP/DBP categories (Figure) among 5280 participants of the Jackson Heart Study (JHS), an exclusively black population. We used Cox proportional hazards models to investigate associations between baseline visit SBP/DBP and both mortality and HFH. Linearity of associations and differential effects by age were assessed. Results: Median age was 56 years (IQR: 46-65); 63% were female; median SBP was 125 mmHg (IQR: 114-137); and median DBP was 79 mmHg (IQR: 72-86). There were 520 deaths over 9 years and 340 HFHs over 7 years. The age-adjusted cumulative incidence of both mortality and HFH increased with SBP, while rates of both outcomes were similar by DBP (Figure). After multivariable adjustment, every 10 mmHg increase in SBP was associated with increased mortality (HR 1.12 95% CI [1.06, 1.17]; p<.001) and HFH (HR 1.07 95% CI [1.00, 1.14]; p=0.05). The mortality risk per 10mmHg increase in SBP was greater in participants <60 years (HR 1.26 95% CI [1.13, 1.42]; p<.001) than ≥ 60 years (HR 1.09 95% CI [1.03, 1.15]; p=.004). DBP was inversely associated with risk of mortality (HR 0.85 95% CI [0.77, 0.94]; p= .002) and not associated with HFH (p=.20). Conclusions: In this JHS cohort, SBP was associated with both mortality and HFH, while DBP was inversely associated with mortality. Adults across all age groups were at increased risk of mortality as SBP increased. In the context of new HTN guidelines, these findings have important implications and should be considered when determining BP treatment goals in Black patients.