Results:

Among 1,628 patients (mean age 81 years) on antihypertensive drugs, 636 (39%) had normalized BP. Normalized and non-normalized patients did not differ by demographics, lifestyle, diabetes, previous stroke, or duration of treated hypertension. The most common antihypertensive drug classes used were diuretics (60%), beta-blockers (59%), angiotensin-converting enzyme inhibitors (50%), calcium channel blockers (34%), and angiotensin-receptor blockers (30%). Overall, 31% were on monotherapy and 69% on combination therapy. There was no significant interaction between history of CVEs or age and BP control. Normalized BP patients were more likely to have a previous myocardial infarction or reduced estimated glomerular filtration rate. At a median follow-up of 73 months with 8,853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with a 26% increased risk of all-cause mortality (number needed to harm [NNH] 3-year 64/6-year 34), which was mainly driven by sBP <130 mm Hg. While there was a trend toward decrease in risk with normalized BP in those ages 70-79 years, there was a 60% increase in total mortality in those ages ≥80 years (NNH 3-year 29/6-year 17) and 39% in those with previous CVE (NNH 3-year 24/6-year 16). There was no change in the results when using a 1-year lag to account for decreasing BP at end of life. When stratifying the normalized group to sBP <130 and dBP <90 mm Hg, there was an increased risk of all-cause mortality but not when categorized as sBP 130-139 mm Hg. Using 140 mm Hg as a reference point, sBP of about 125 mm Hg was significantly associated with increased risk, which was not the case with higher values of sBP (reversed J-shaped curve).