Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control

Beddhu, Srinivasan; Chertow, Glenn M.; Cheung, Alfred K.; Cushman, William C.; Rahman, Mahboob; Greene, Tom; Wei, Guo; Campbell, Ruth; Conroy, M. F.; Freedman, Barry I.; Haley, William E.; Horwitz, Edward; Kitzman, Dalane W.; Lash, James P.; Papademetriou, Vasilios; Pisoni, Roberto; Riessen, Erik; Rosendorff, Clive; Watnick, Suzanne; Whittle, Jeff; Whelton, Paul K.

doi:10.1161/circulationaha.117.030848

Cited by 142 publications

(109 citation statements)

References 26 publications

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“…Our findings were similar to a recent study in which the authors analysed pooled data from ACCORD and SPRINT, and reported a J‐curve regarding the relationship between on‐treatment BP and cardiovascular outcomes. Whether or not the J‐curve phenomenon exists remains debatable . Recently, two large scale meta‐analyses which assessed the effects of BP lowering on cardiovascular outcomes reported the benefit of BP lowering even in patients with a baseline SBP <130 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Systolic blood pressure trajectory and cardiovascular outcomes: An analysis using data in the Systolic Blood Pressure Intervention Trial

Lee

Wang

2019

Int J Clin Pract

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Background Blood pressure changes in response to medication intensification differ over time across individuals, and could affect their cardiovascular outcomes. We aimed to investigate the relationship between systolic blood pressure (SBP) trajectory and cardiovascular outcomes using data from the Systolic Blood Pressure Intervention Trial (SPRINT). Methods Groups of SBP trajectory were modelled separately in the standard and intensive treatment groups. SBP at each site visit post randomisation were used for modelling by group‐based trajectory with latent class growth model. We classified six SBP trajectories (on target [reference group], near target, and off target in the intensive treatment group; on target‐below 130, on target‐below 140, and off target in the standard treatment group). A Cox‐proportional hazard model was used to analyse the effects of SBP trajectory on the primary composite outcome, death from any cause, and the composite of the primary outcome or death from any cause. Results The respective mean SBP was 119 ± 5, 128 ± 6, 141 ± 8, 124 ± 4, 136 ± 4, and 147 ± 6 mm Hg. With respect to the primary composite outcomes, the standard‐on target (below 130) had the highest risk (adjusted hazard ratio [lower to upper confidence interval], 2.525 [1.865‐3.420]), despite its mean SBP was the second lowest of the six groups. The standard‐on target (below 140) had a higher risk (1.323 [1.056‐1.657]) when compared with the intensive‐on target. However, the standard‐on target (below 140) had a similar risk (1.12 [0.861‐1.458]) when compared with the intensive‐near target, despite an 8 mm Hg difference in mean SBP (136 vs 128 mm Hg, P < .001). Conclusion An SBP treatment target of <120 mm Hg was only associated with a better cardiovascular outcome compared with a treatment target of <140 mm Hg, provided that the target of <120 mm Hg was reached. Trial registration: ClinicalTrials.gov NCT01206062. Registered 21 September 2010.

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Section: Discussionmentioning

confidence: 99%

Systolic blood pressure trajectory and cardiovascular outcomes: An analysis using data in the Systolic Blood Pressure Intervention Trial

Lee

Wang

2019

Int J Clin Pract

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“…Data from Heart Outcomes Prevention Evaluation (HOPE3) showed no benefit of BP lower less than 140/90 mmHg in patients with intermediate risk, which emphasizes the importance of addressing the CV risks when tailoring BP goals. One size may not fit all, the ESC/ESH guidelines goals may be more feasible in patients with poor vascular compliance, orthostatic hypotension, and high pulse pressures …”

Section: Current Evidence and Guidelinesmentioning

confidence: 99%

“…One size may not fit all, the ESC/ESH guidelines goals may be more feasible in patients with poor vascular compliance, orthostatic hypotension, and high pulse pressures. 33,43,65 The consensus documents looked at the same evidence and came up with different recommendations. When reviewing the data from the "minority view" paper in Annals there is a statistical type II misinterpretation of the data.…”

Section: Data From the Second National Health And Nutrition Examinationmentioning

confidence: 99%

Hypertension in older adults: Assessment, management, and challenges

Oliveros

Patel

Kyung

et al. 2019

Clinical Cardiology

293

149

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Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.

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“…A further analysis published in Circulation [22] in 2018 considered whether there was any effect of reducing diastolic pressure when targeting 120 mm Hg systolic. The results showed that when decreasing the baseline diastolic pressure a further reduction of blood pressure did cause an increase in mortality, but the mortality was still lower than with standard treatment.…”

Section: Hypertension: a J (Ton) Rabelink (The Netherlands)mentioning

confidence: 99%