Determination of the optimal on-treatment diastolic blood pressure range using automated office measurements in patients without cardiovascular disease.

Abstract

Optimal diastolic blood pressure (DBP) during antihypertensive treatment in patients without a history of cardiovascular disease (CVD) remains unknown. This post‑hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) data aimed to determine the optimal DBP evaluated using automated office blood pressure measurements (AOBPM) in hypertensive patients without a history of CVD. Data of 1470 patients with CVD and 7117 patients without CVD were used. Clinical composite endpoint (CE) was defined as the occurrence of myocardial infarction, acute coronary syndrome other than myocardial infarction, decompensation of heart failure, stroke, or cardiovascular death. Two different approaches based on the hazard ratio plot were used to identify the optimal DBP range. The first approach was to determine the 10 mm Hg-wide DBP range with the lowest risk for CE. In the second approach, it was assumed that the hazard ratio of CE at the boundary points of the optimal DBP range should be the same in patients with and without CVD. Two ranges of on-treatment DBP were proposed: 73.7 to 83.7 mm Hg (first approach) and 63.6 to 95.8 mm Hg (second approach). The risk for CE was increased by 3% and 20% at the boundary points of the range, respectively, depending on the method of DBP determination. Due to the fact that the range determined by the second method was wide and substantially different from the one recommended by the European Society of Cardiology (70-79 mm Hg), we have concluded that a DBP range of 73.7 to 83.7 mm Hg, measured using AOBPM, should be considered optimal in patients without CVD.