@article{ref1,
title="Low systolic blood pressure from treatment and association with serious falls/syncope",
journal="American journal of preventive medicine",
year="2018",
author="Sim, John J. and Zhou, Hui and Bhandari, Simran and Wei, Rong and Brettler, Jeff W. and Tran-Nguyen, Jocelyn and Handler, Joel and Shimbo, Daichi and Jacobsen, Steven J. and Reynolds, Kristi",
volume="55",
number="4",
pages="488-496",
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). <br><br>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. <br><br>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. <br><br>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.<br><br>Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0749-3797",
doi="10.1016/j.amepre.2018.05.026",
url="http://dx.doi.org/10.1016/j.amepre.2018.05.026"
}