TARGET DIASTOLIC BLOOD PRESSURE RANGE ACCORDING TO THE AGE CATEGORY AND PRESENCE OF PRIOR CARDIOVASCULAR DISEASE DURING ANTIHYPERTENSIVE TREATMENT

Abstract

Objective: The evidence supporting European Society of Cardiology (ESC) recommended target diastolic blood pressure (DBP) in range 70–79 mm Hg is scarce. The study was aimed to evaluate optimal DBP according to age category (< 65 years, 65–80 years, > 80 years) and presence of cardiovascular disease (CVD). Design and method: Analysis was performed using Systolic Blood Pressure Intervention Trial (SPRINT) data shared by National Heart, Lung and Blood Institute. On-treatment DBP was computed as a mean of DBP measurements made in period from 6th month of participation to the end of the study, when BP was stable. Composite outcome event (CE) included myocardial infarction and other acute coronary syndrome, stroke, heart failure decompensation and cardiovascular death. Adjusted Cox proportional models were used to establish association between DBP and hazard ratio according to age category and presence of CVD. Results: Data of 8890 SPRINT participants (aged 67.8 ± 9.4 years) with available data were analysed. 3139 (35.3%) were female and 1773 (19.9%) were diagnosed with prior CVD. There was 3049 (42.8%) participants younger than 65 years, 3288 (46.2%) in age 65–80 years and 780 (11%) older than 80 years in group without prior CVD. There was 583 (32.9%) participants younger than 65 years, 891 (50.3%) in age 65–80 years and 299 (16.9%) older than 80 years in group with prior CVD. There was 293 (4.1%) CE events in group without prior CVD and 168 (9.5%) CE events in participants with prior CVD. Figure 1 presents the relationship between DBP and hazard ratio according to age category and presence of CVD. Conclusions: Optimal DBP range for patients with hypertension and CVD younger than 80 years is similar to the recommended interval 70–79 mm Hg. Similar DBP target should be recommended for younger than 65 years adults with hypertension but without prior CVD. DBP range 70–79 mm Hg should be reconsidered as a treatment target in subjects without prior CVD older than 65 years and in subjects with prior CVD older than 80 years.