Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure
Background The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on‐treatment systolic blood pressure on major adverse cardiovascular events (MACEs) is uncertain. This study examined whether treated isolated diastolic hypertension (IDH) and treated isolated low DBP (IL...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032771 |
| _version_ | 1797205528177278976 |
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| author | Wei‐Lun Chang Ying‐Fan Chen Yu‐Hsuan Lee Ming‐Neng Shiu Po‐Yin Chang Chao‐Yu Guo Chi‐Jung Huang Chern‐En Chiang Chen‐Huan Chen Shao‐Yuan Chuang Hao‐Min Cheng |
| author_facet | Wei‐Lun Chang Ying‐Fan Chen Yu‐Hsuan Lee Ming‐Neng Shiu Po‐Yin Chang Chao‐Yu Guo Chi‐Jung Huang Chern‐En Chiang Chen‐Huan Chen Shao‐Yuan Chuang Hao‐Min Cheng |
| author_sort | Wei‐Lun Chang |
| collection | DOAJ |
| description | Background The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on‐treatment systolic blood pressure on major adverse cardiovascular events (MACEs) is uncertain. This study examined whether treated isolated diastolic hypertension (IDH) and treated isolated low DBP (ILDBP) were associated with MACEs in patients with hypertension. Methods and Results A total of 7582 patients with on‐treatment systolic blood pressure <130 mm Hg from SPRINT (Systolic Blood Pressure Intervention Trial) were categorized on the basis of average DBP: <60 mm Hg (n=1031; treated ILDBP), 60 to 79 mm Hg (n=5432), ≥80 mm Hg (n=1119; treated IDH). MACE risk was estimated using Cox proportional‐hazards models. Among the SPRINT participants, median age was 67.0 years and 64.9% were men. Over a median follow‐up of 3.4 years, 512 patients developed a MACE. The incidence of MACEs was 3.9 cases per 100 person‐years for treated ILDBP, 1.9 cases for DBP 60 to 79 mm Hg, and 1.8 cases for treated IDH. Comparing with DBP 60 to 79 mm Hg, treated ILDBP was associated with an 1.32‐fold MACE risk (hazard ratio [HR], 1.32, 95% CI, 1.05–1.66), whereas treated 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). Conclusions In this secondary analysis of SPRINT, among treated patients with normalized systolic blood pressure, excessively low DBP was associated with an increased MACE risk, while treated IDH was not. Further research is required for treated ILDBP management. |
| first_indexed | 2024-04-24T08:52:33Z |
| format | Article |
| id | doaj.art-bdeed504054e4483bfb1edbbde7fe523 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T08:52:33Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-bdeed504054e4483bfb1edbbde7fe5232024-04-16T09:33:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113810.1161/JAHA.123.032771Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood PressureWei‐Lun Chang0Ying‐Fan Chen1Yu‐Hsuan Lee2Ming‐Neng Shiu3Po‐Yin Chang4Chao‐Yu Guo5Chi‐Jung Huang6Chern‐En Chiang7Chen‐Huan Chen8Shao‐Yuan Chuang9Hao‐Min Cheng10Division of Faculty Development Taipei Veterans General Hospital Taipei TaiwanDepartment of Internal Medicine Taipei Veterans General Hospital Taipei TaiwanDivision of Faculty Development Taipei Veterans General Hospital Taipei TaiwanDepartment of Pharmacy, College of Pharmaceutical Sciences National Yang Ming Chiao Tung University Taipei TaiwanOffice of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring MD USADivision of Biostatistics and Data science Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University Taipei TaiwanCenter for Evidence‐based Medicine Taipei Veterans General Hospital Taipei TaiwanSchool of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei TaiwanSchool of Medicine, College of Medicine National Yang Ming Chiao Tung University Taipei TaiwanInstitute of Population Health Science, National Health Research Institutes Miaoli County TaiwanDivision of Faculty Development Taipei Veterans General Hospital Taipei TaiwanBackground The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on‐treatment systolic blood pressure on major adverse cardiovascular events (MACEs) is uncertain. This study examined whether treated isolated diastolic hypertension (IDH) and treated isolated low DBP (ILDBP) were associated with MACEs in patients with hypertension. Methods and Results A total of 7582 patients with on‐treatment systolic blood pressure <130 mm Hg from SPRINT (Systolic Blood Pressure Intervention Trial) were categorized on the basis of average DBP: <60 mm Hg (n=1031; treated ILDBP), 60 to 79 mm Hg (n=5432), ≥80 mm Hg (n=1119; treated IDH). MACE risk was estimated using Cox proportional‐hazards models. Among the SPRINT participants, median age was 67.0 years and 64.9% were men. Over a median follow‐up of 3.4 years, 512 patients developed a MACE. The incidence of MACEs was 3.9 cases per 100 person‐years for treated ILDBP, 1.9 cases for DBP 60 to 79 mm Hg, and 1.8 cases for treated IDH. Comparing with DBP 60 to 79 mm Hg, treated ILDBP was associated with an 1.32‐fold MACE risk (hazard ratio [HR], 1.32, 95% CI, 1.05–1.66), whereas treated 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). Conclusions In this secondary analysis of SPRINT, among treated patients with normalized systolic blood pressure, excessively low DBP was associated with an increased MACE risk, while treated IDH was not. Further research is required for treated ILDBP management.https://www.ahajournals.org/doi/10.1161/JAHA.123.032771major adverse cardiovascular eventstreated isolated diastolic hypertensiontreated isolated low diastolic blood pressure |
| spellingShingle | Wei‐Lun Chang Ying‐Fan Chen Yu‐Hsuan Lee Ming‐Neng Shiu Po‐Yin Chang Chao‐Yu Guo Chi‐Jung Huang Chern‐En Chiang Chen‐Huan Chen Shao‐Yuan Chuang Hao‐Min Cheng Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease major adverse cardiovascular events treated isolated diastolic hypertension treated isolated low diastolic blood pressure |
| title | Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure |
| title_full | Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure |
| title_fullStr | Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure |
| title_full_unstemmed | Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure |
| title_short | Cardiovascular Risk in Patients With Treated Isolated Diastolic Hypertension and Isolated Low Diastolic Blood Pressure |
| title_sort | cardiovascular risk in patients with treated isolated diastolic hypertension and isolated low diastolic blood pressure |
| topic | major adverse cardiovascular events treated isolated diastolic hypertension treated isolated low diastolic blood pressure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032771 |
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