Faculty Collaboration Database

Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control. Circulation 2018 Jan 09;137(2):134-143

Date

10/13/2017

Pubmed ID

29021322

Pubmed Central ID

PMC5760457

DOI

10.1161/CIRCULATIONAHA.117.030848

Scopus ID

2-s2.0-85043686285 (requires institutional sign-in at Scopus site)   126 Citations

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 <120 mm Hg) and standard (target <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 (P 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 P 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.

Author List

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

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

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