{"id":"46093","type":"article","url":"https://hartvaat.nl/2026/04/07/bij-2-3-miljoen-amerikaanse-veteranen-was-de-sterfte-het-laagst-bij-een-systolis/","title":"Bij 2,3 miljoen Amerikaanse veteranen was de sterfte het laagst bij een systolische bloeddruk van 130-139 mmHg","title_en":"Blood Pressure Control and Mortality Among US Veterans","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25787","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.125.25787","authors":["Masaaki Yamada"],"significance":7,"published":"2026-07-24","source_date":"2026-04-07","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"Intensive blood-pressure lowering reduces mortality and cardiovascular disease in clinical trials, but real-world BP measurements often differ from standardised protocols. In this retrospective cohort of over 2.3 million US Veterans with hypertension (mean age 66; 36% diabetes, 22% cardiovascular disease, 19% kidney disease), systolic BP was treated as a time-dependent variable across seven categories. Lowest mortality was seen at a systolic BP of 130-139 mmHg. Compared with a year at BP ≥160 mmHg, adjusted hazard ratios included 1.29 at <110, 0.83 at 130-139 and 0.86 at 140-149 mmHg — a J-shaped relationship consistent across patients with and without cardiovascular or kidney disease. In routine practice, a somewhat higher BP target thus appears appropriate, especially for older patients with comorbidity.","created":"2026-07-03T20:27:19Z","updated":"2026-07-04T19:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Intensieve bloeddrukverlaging vermindert sterfte en hart- en vaatziekten in klinische trials, maar bloeddrukmetingen in de praktijk wijken vaak af van het gestandaardiseerde protocol. In deze retrospectieve cohortstudie onder ruim 2,3 miljoen Amerikaanse veteranen met hypertensie (gemiddeld 66 jaar; 36% diabetes, 22% hart- en vaatziekte, 19% nierziekte) werd de systolische bloeddruk als tijdsafhankelijke variabele in zeven categorieën ingedeeld. De laagste sterfte werd gezien bij een systolische bloeddruk van 130-139 mmHg. Ten opzichte van een jaar met een bloeddruk ≥160 mmHg waren de gecorrigeerde hazard ratio's onder andere 1,29 bij <110, 0,83 bij 130-139 en 0,86 bij 140-149 mmHg — een J-vormig verband dat consistent was bij patiënten met en zonder hart- en vaatziekte of nierziekte. In de dagelijkse praktijk lijkt een wat hogere bloeddrukstreefwaarde dus passend, vooral bij oudere patiënten met comorbiditeit.","abstract_original":"Hypertension, Volume 83, Issue 6, Page e25787, June 1, 2026. BACKGROUND:Intensive blood pressure (BP) control reduces mortality and cardiovascular disease in clinical trials. However, real-world BP measurements often differ from standardized protocols. We evaluated the impact of real-world systolic BP on mortality among US Veterans.METHODS:We conducted a retrospective cohort study of Veterans with hypertension, defined by diagnostic codes, antihypertensive prescriptions, or ≥2 office BP readings ≥130/90 mm Hg in 2016 to 2017, with follow-up through March 2021. Systolic BP was treated as a time-dependent covariate and categorized into 7 groups: &amp;lt;110, 110−119, 120−129, 130−139, 140−149, 150−159, and ≥160 mm Hg. Discrete-time survival models assessed associations with all-cause mortality, adjusting for demographics, body mass index, and comorbidities. Stratified analyses were conducted based on cardiovascular disease and chronic kidney disease status.RESULTS:Among &amp;gt;2.3 million Veterans (mean age, 66 years; 36% with diabetes; 22% with cardiovascular disease; and 19% with chronic kidney disease), the lowest mortality risk was observed in those with systolic BP of 130 to 139 mm Hg. In this cohort, adjusted hazard ratios for all-cause mortality per year in each systolic BP category were 1.29 for BP &amp;lt;110; 1.03 for BP 110 to 119; 0.88 for BP 120 to 129; 0.83 for BP 130 to 139; 0.86 for BP 140 to 149; and 0.89 for BP 150 to 159 mm Hg, compared with a year with BP ≥160 mm Hg. These associations remained consistent across cardiovascular disease and chronic kidney disease subgroups.CONCLUSIONS:Veterans with routine systolic BP of 130 to 139 mm Hg had the lowest mortality. These findings suggest that a higher BP target may be appropriate in clinical practice, especially for older adults with comorbidities."}