Cardiovascular risk in treated hypertensive patients with isolated diastolic hypertension and isolated low diastolic blood pressure

Abstract

AbstractBackgroundThe prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on-treatment systolic blood pressure (SBP) on major adverse cardiovascular events (MACE) is uncertain. This study examined whether isolated diastolic hypertension (IDH) and isolated low DBP (ILDBP) were associated with MACE in treated patients.Methods7582 hypertensive patients with on-treatment SBP <130 mmHg from the Systolic Blood Pressure Intervention Trial (SPRINT) were categorized based on average DBP: <60 mmHg (n=1031; ILDBP), 60–79 mmHg (n=5432), ≥80 mmHg (n=1119; IDH). MACE risk was estimated using Cox proportional hazards models. The analysis was supplemented by a meta-analysis involving 10106 SPRINT and four cohort participants.ResultsMedian age of the SPRINT participants was 67.0 years, and 64.9% were men. Over a median follow-up of 3.4 years, 512 patients developed MACE. The incidence of MACE was 3.9 cases per 100 person-years for ILDBP, 1.9 cases for DBP 60–79 mmHg, and 1.8 cases for IDH. ILDBP was associated with 1.32-fold increased MACE risk (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05–1.66), whereas IDH was not (HR: 1.18, 95% CI: 0.87–1.59). There was no effect modification by age, sex, atherosclerotic cardiovascular disease risk, or cardiovascular disease history (all p-values for interaction >0.05). The meta-analysis indicated increased MACE risk in ILDBP (HR: 1.26, 95% CI: 1.05–1.52) compared with DBP 60–79 mmHg.ConclusionsIn treated patients with normalized SBP, excessively low DBP was associated with increased MACE risk, while IDH was not. Further research is required for ILDBP management.