Abstract
Recent studies including the SPRINT trial have shown beneficial effects of intensive systolic blood pressure reduction over the standard approach. The awareness of the J-curve for diastolic blood pressure (DBP) causes some uncertainty regarding the net clinical effects of blood pressure reduction. The current analysis was performed to investigate effects of low on-treatment DBP on cardiovascular risk in the SPRINT population. The primary composite outcome was the occurrence of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. The prevalence of primary outcomes was significantly higher in subjects within low DBP in both standard (44–67 mmHg [10.8%] vs 67–73 mmHg [6.7%] vs 73–78 mmHg [5.1%] vs 78–83 mmHg [4.4%] vs 83–113 mmHg [4.3%], p < 0.001) and intensive treatment (38–61 mmHg [6.7%] vs 61–66 mmHg [4.1%] vs 66–70 mmHg [4.5%] vs 70–74 mmHg [2.7%] vs 74–113 mmHg [3.4%], p < 0.001) arms. After adjusting for covariates, low DBP showed no significant effects on cardiovascular risk. Therefore, while reaching blood pressure targets, low DBP should not be a matter of concern.
Highlights
The American College of Cardiology, American Heart Association and the European Society of Cardiology, recently adopted new goals for antihypertensive therapy following the release of results from new clinical studies including the Systolic Blood Pressure Intervention Trial (SPRINT)[1,2,3]
This study shows that diastolic blood pressure (DBP) is not an independent risk factor for cardiovascular events
Three other studies based on SPRINT data investigated the J-curve hypothesis of DBP
Summary
The American College of Cardiology, American Heart Association and the European Society of Cardiology, recently adopted new goals for antihypertensive therapy following the release of results from new clinical studies including the Systolic Blood Pressure Intervention Trial (SPRINT)[1,2,3]. SPRINT showed that achieving systolic blood pressure (SBP) of less than 120 mmHg, rather than 140 mmHg, contributed to reduced risks of fatal and nonfatal major cardiovascular events and overall mortality. In 1979 it was shown that lower diastolic blood pressure (DBP) may increase the risk of myocardial infarction among hypertensive patients[5,6]. The J- shape of the curve was more pronounced for DBP than for SBP, and the risk of myocardial infarction and death increased when the DBP was
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