Individualizing the target diastolic blood pressure in patients being treated for hypertension and diabetes

Abstract

Abstract Background/Introduction The J-curve hypothesis in hypertension is related to an increased risk of cardiovascular events associated with both too high and too low diastolic blood pressure (DBP) values. European Society of Cardiology recommended DBP in the range of 70–80 mm Hg as a treatment target for subjects with hypertension, regardless of age, history of cardiovascular disease (CVD) or diabetes mellitus (DM) presence. Such a recommendation is based on studies performed in subjects with prior CVD. There is no scientific evidence to support a target DBP of 70–80 mmHg in people with DM and without history of CVD. Purpose The aim of the study is to determine the relationship between DBP and cardiovascular risk according to age and the presence of CVD in people with DM. Methods The ACCORD study dataset (participants with diabetes) available from National Heart, Lung and Blood Institute was used to perform the analysis. The DBP value during the study was defined as the mean of all DBP measurements obtained during the study individually for each participant. The composite endpoint (CE) was defined as myocardial infarction, stroke, exacerbation of heart failure or cardiovascular death. The relationship between the DBP value during the study and the risk of CE was presented using the Cox proportional hazard model and spline curves. This analysis was performed for 4 sub-populations defined on the basis of 2 criteria: age <65 years and the presence of CVD in the past. Each model was adjusted for other cardiovascular risk factors (age, sex, smoking, systolic blood pressure, chronic kidney disease). Results The data of 4,733 participants of the ACCORD BP study were analyzed. The table (Figure 1) presents the baseline characteristics of the 4 sub-populations and CE occurrence. For each sub-population studied, a Cox model describing the relationship between DBP during the study and CE risk was developed and presented in the Figure 2. In subjects with CVD the J-curve relationship between DBP and CE risk was observed. Among subjects without prior CVD, no J-curve relationship was observed. Conclusions Optimal DBP treatment target in subjects with CVD and DM is slightly lower than the currently recommended range of 70–80 mm Hg. DBP values in the range of 70–80 mm Hg should not be recommended as the treatment target for subjects with DM and no history of CVD. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2