title: Low blood pressure and antihypertensive treatment are independently associated with physical and mental health status in patients with arterial disease: the SMART study.
abstract: OBJECTIVE
  To investigate the independent effects of antihypertensive treatment and blood pressure (BP) levels on physical and mental health status in patients with arterial disease.
  
  
  METHODS
  Cross-sectional analyses were conducted within the single-centre Secondary Manifestations of ARTerial disease (SMART) study, in a hospital care setting.
  
  
  METHODS
  A total of 5877 patients (mean age 57 years) with symptomatic and asymptomatic arterial disease underwent standardized vascular screening.
  
  
  METHODS
  The primary outcome was self-rated physical and mental health assessed using the 36-item short-form health survey.
  
  
  RESULTS
  In the total population, antihypertensive drug use and increased intensity of antihypertensive treatment were associated with poorer health status independent of important confounders including BP levels; adjusted mean differences [95% confidence interval (CI)] in physical and mental health between n = 0 and n ≥ 3 antihypertensives were -1.2 (-2.1; -0.3) and -3.5 (-4.4; -2.6), respectively. Furthermore, both lower systolic and lower diastolic BP levels were related to poorer physical and mental health status independent of antihypertensive treatment. Mean differences (95% CI) in physical and mental health status per SD decrease in systolic BP were -0.56 (-0.84; -0.27) and -0.32 (-0.61; -0.03) and per SD decrease in diastolic BP were -0.50 (-0.78; -0.23) and -0.08 (-0.36; 0.20), respectively. The association between low BP and poor health status was particularly present in patients with coronary artery disease.
  
  
  CONCLUSIONS
  In a population of patients with asymptomatic and symptomatic arterial disease, antihypertensive treatment and lower BP levels are independently associated with poorer self-rated physical and mental health. These findings suggest that different underlying mechanisms may explain these independent associations.
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Muller
authors.forename: H M
authors.initials: HM
authors.lastname: Jochemsen
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
authors.forename: A M
authors.initials: AM
authors.lastname: Grool
authors.forename: L J
authors.initials: LJ
authors.lastname: Launer
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: M I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007022:Hypotension / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive treatment; blood pressure; cardiovascular disease; mental health; physical health