Impact of blood pressure control level on all-cause mortality and CVD mortality in patients with hypertension and its comorbidities: A prospective cohort study in Southwest China

Background: Blood pressure control levels may be associated with the risk of all-cause mortality and CVD mortality. The goal of this study was to explore the association of BP control levels with the risk of all-cause mortality and CVD mortality in adults in Guizhou, China. Methods: A 13-year prospective cohort study of 1,905 hypertension patients aged 18 years or older was conducted in Guizhou, southwest China from 2010 to 2023. Information of participants death were collected, cause of death was coded according to ICD-10 and codes I00-I99 was categorized as CVD-related deaths. Cox proportional hazard regression was used to examine the associations of BP control levels with all-cause mortality and CVD mortality. Results: 134 deaths occurred during a median follow-up of 11.72 years. The multivariable cox hazard regression models showed that compared with SBP?140mmHg and DBP?90mmHg group, participants with SBP <120mmHg and DBP <80mmHg, they had the lowest risk of all-cause mortality (HR=0.265, 95%CI:0.111,0.630) and the lower risk of CVD death (HR=0.274, 95%CI:0.092,0.814). Associations between BP control levels with all-cause mortality and CVD mortality were suggested to be even stronger among aged ?65 years (P<0.05), but ideal BP levels were not significantly associated with CVD mortality in participants with comorbidity (P>0.05). Conclusion: Optimal BP control levels(<120/80mmHg) is effective in reducing overall mortality and cardiovascular disease (CVD) mortality, even among older adults. however, for hypertension with comorbidities, mere BP control alone may not suffice, consideration should also be given to the treatment of other coexisting conditions. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Guizhou Province Science and Technology Support Program [Grant number: Qiankehe (2018)2819] and Provincial Key Construction Discipline Project of Guizhou Provincial Health Commission. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Institutional Review Board of the Guizhou Center for Disease Control and Prevention (No. S2017-02) and written informed consent was obtained from all participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Application for datasets generated during and/or analysed during the current study may be considered by the corresponding author on reasonable request.