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Systolic and diastolic blood pressure lowering as determinants of cardiovascular outcome

Ji-Guang Wang1, Jan A Staessen, Stanley S Franklin

  • 1Study Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Belgium.

Hypertension (Dallas, Tex. : 1979)
|April 20, 2005
PubMed

Insights

Lowering systolic blood pressure (SBP) with antihypertensive drugs is key for cardiovascular prevention, especially in older adults. The reduction in diastolic blood pressure (DBP) had a lesser impact on preventing cardiovascular events.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Trials

Background:

  • Hypertension is a major risk factor for cardiovascular disease.
  • The relative contributions of systolic blood pressure (SBP) and diastolic blood pressure (DBP) lowering to cardiovascular prevention remain debated.
  • Individual patient data from hypertension trials offer a robust approach to investigate treatment effects across different age groups.

Purpose of the Study:

  • To quantitatively assess the impact of lowering SBP and DBP on cardiovascular prevention in hypertensive patients.
  • To investigate how the age of patients influences the effectiveness of antihypertensive treatment.
  • To determine whether SBP or DBP reduction is the primary driver of cardiovascular risk reduction.

Main Methods:

  • A quantitative overview of randomized controlled trials comparing active antihypertensive drugs to placebo or no treatment.
  • Inclusion of individual patient data from 11 trials involving over 28,000 patients across three age strata: young (30-49), old (60-79), and very old (>=80).
  • Analysis of SBP and DBP reduction, their ratio, and their association with cardiovascular events, stroke, and myocardial infarction.

Main Results:

  • Antihypertensive treatment significantly reduced SBP and DBP across all age groups, with varying ratios of DBP to SBP lowering.
  • Cardiovascular event risk, stroke, and myocardial infarction were reduced similarly across all age strata, despite differential blood pressure lowering.
  • Absolute cardiovascular benefit increased with age and was associated with a lower DBP/SBP lowering ratio.
  • A greater reduction in SBP consistently reduced risks, irrespective of DBP reduction or achieved DBP levels.

Conclusions:

  • Antihypertensive drug treatment primarily improves cardiovascular outcomes through the reduction of systolic blood pressure.
  • The magnitude of SBP reduction is a more critical factor in cardiovascular prevention than DBP reduction.
  • Treatment benefits are substantial across all adult age groups, with increased absolute benefits observed in older individuals.

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