Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120-140 mmHg) and...

Area of Science:

• Cardiology
• Hypertension Management
• Clinical Trials

Background:

• Current hypertension guidelines focus on upper limits for systolic blood pressure (SBP) and diastolic blood pressure (DBP).
• J-curve associations suggest that very low DBP may also increase risks for certain cardiovascular outcomes.
• The optimal DBP target, particularly in patients with controlled SBP, requires further investigation.

Purpose of the Study:

• To examine the association between mean attained DBP and cardiovascular (CV) outcomes in high-risk patients.
• To investigate these associations within a specific SBP range (120 to <140 mmHg) identified as having the lowest CV risk.
• To inform hypertension management strategies by evaluating the impact of DBP levels at optimal SBP control.

Main Methods:

• Analysis of outcome data from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized Assessment in ACE Intolerant participants with cardiovascular Disease (TRANSCEND) trials.
• Inclusion of patients aged 55 years or older with CV disease and controlled on-treatment SBP (120 to <140 mmHg).
• Assessment of composite CV outcomes, specific components, and all-cause mortality according to mean on-treatment DBP categories and as a continuous variable.

Main Results:

• Among 16,099 patients with SBP 120 to <140 mmHg, the lowest risk for all outcomes was observed at a DBP of 70 to <80 mmHg.
• Higher DBP (≥80 mmHg) was linked to increased risk of stroke, heart failure hospitalization, and myocardial infarction (≥90 mmHg).
• Lower DBP (<70 mmHg) was associated with higher risks for the primary composite outcome, myocardial infarction, heart failure hospitalization, and all-cause death.

Conclusions:

• Both lower (<70 mmHg) and higher (≥80 mmHg) DBP levels are associated with increased cardiovascular risk when SBP is optimally controlled (120 to <140 mmHg).
• The findings support current guidelines that consider DBP in hypertension management, especially at controlled SBP.
• These results underscore the importance of monitoring and managing DBP to minimize cardiovascular risk in high-risk patients.