Retrospective cohort study assessing cardiovascular risk reduction through intensive blood pressure management in high-risk patients.

BACKGROUND

Hypertension remains a major global risk factor for cardiovascular disease. While clinical trials suggest that lower systolic blood pressure (SBP) levels reduce cardiovascular risk, real-world data from high-risk patients remain limited. This study evaluated the association between achieved SBP levels and cardiovascular outcomes in a high-risk hypertensive population.

METHODS

We performed a retrospective cohort study from January 2022 to December 2024, including 180 high-risk hypertensive patients receiving treatment at a tertiary care facility. Patients were categorized based on achieved systolic blood pressure during follow-up: one group with SBP <120 mmHg and another with SBP between 130 and 139 mmHg. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure, and cardiovascular-related death or hospitalization. The secondary outcomes consisted of all-cause mortality and adverse treatment events.

RESULTS

Patients in the lower achieved SBP group had significantly fewer MACE events over a median follow-up of 18 months compared with those in the higher SBP group (14.8 vs. 26.5, p = 0.03). Treatment was considered to be particularly of benefit for patients with diabetes and chronic kidney disease because the relative risk reduction was 30% compared to routine control. There was attenuation of benefits in elderly patients, i.e., where age was over 75. Adverse events, including hypotension and renal impairment, were slightly more common in the lower SBP group but remained clinically manageable (9.3% vs. 4.8%; p = 0.60).

CONCLUSION

Among high-risk hypertensive patients, lower achieved SBP levels were associated with reduced cardiovascular event rates. These findings support the need for further prospective studies to define optimal BP targets, especially in patients with diabetes and chronic kidney disease.