Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control.

Pubmed ID: 29021322

Pubmed Central ID: PMC5760457

Journal: Circulation

Publication Date: Jan. 9, 2018

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Middle Aged, Hypertension, Treatment Outcome, Blood Pressure, Incidence, Puerto Rico, Myocardial Infarction, Time Factors, Renal Insufficiency, Chronic, Diastole, Antihypertensive Agents, Acute Coronary Syndrome

Grants: UL1 TR000445, UL1 TR000005, HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, P30 GM103337, UL1 TR000433, UL1 TR000439, UL1 TR000002, UL1 TR001064, UL1 TR000064, UL1 TR000075, UL1 RR025752, UL1 RR025771, UL1 TR000093, UL1 TR000003, UL1 TR000050, UL1 TR000073, UL1 RR025755, UL1 TR000105, UL1 RR024134, UL1 RR025764, C06 RR011234, R01 DK091437, R21 DK106574, UL1 TR001427, UL1 TR002240, UL1 TR002003

Authors: Campbell RC, Beddhu S, Greene T, Rahman M, Cheung AK, Chertow GM, Whelton PK, Cushman WC, Kitzman D, Horwitz E, Papademetriou V, Haley W, Lash J, Wei G, Pisoni R, Rosendorff C, Whittle J, Conroy M, Freedman BI, Riessen E, Watnick SG

Cite As: Beddhu S, Chertow GM, Cheung AK, Cushman WC, Rahman M, Greene T, Wei G, Campbell RC, Conroy M, Freedman BI, Haley W, Horwitz E, Kitzman D, Lash J, Papademetriou V, Pisoni R, Riessen E, Rosendorff C, Watnick SG, Whittle J, Whelton PK, SPRINT Research Group. Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control. Circulation 2018 Jan 9;137(2):134-143. Epub 2017 Oct 11.

Studies:

Abstract

BACKGROUND: In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear. METHODS: SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target &lt;120 mm Hg) and standard (target &lt;140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP. RESULTS: Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level (<i>P</i> for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction <i>P</i> value of 0.78. Results were similar for all-cause death and kidney events. CONCLUSIONS: Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.