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Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood

Dae-Hee Kim1, In-Jeong Cho2, Woohyeun Kim3

  • 1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Korean Circulation Journal
|April 7, 2022
PubMed

Insights

Elevated diastolic blood pressure (DBP) according to JNC7 guidelines increases cardiovascular event risk, even when systolic blood pressure (SBP) is controlled. The 2017 ACC/AHA guidelines showed a link only to stroke risk.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Public Health

Background:

  • Hypertension management guidelines differ in their definitions of elevated blood pressure.
  • Assessing the impact of different diastolic blood pressure (DBP) thresholds on cardiovascular outcomes is crucial for optimizing treatment strategies.
  • Understanding the association between on-treatment blood pressure levels and cardiovascular events is vital for patient care.

Purpose of the Study:

  • To investigate the association between cardiovascular events and two distinct levels of elevated on-treatment diastolic blood pressure (DBP).
  • To compare the risk of major cardiovascular events when systolic blood pressure (SBP) targets are met but DBP remains elevated, using different guideline definitions.
  • To provide evidence for setting appropriate DBP targets in patients who have achieved their SBP targets.

Main Methods:

  • A nationwide, population-based cohort study involving 237,592 treated hypertensive patients.
  • Primary endpoint: composite of cardiovascular death, myocardial infarction, and stroke.
  • Elevated DBP was defined using the Seventh Report of the Joint National Committee (JNC7) and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines.

Main Results:

  • Elevated on-treatment DBP by JNC7 definition was linked to increased risk of the primary endpoint (aHR, 1.14; 95% CI, 1.05-1.24).
  • JNC7-defined elevated DBP was associated with higher risks of cardiovascular mortality (aHR, 1.42) and stroke (aHR, 1.19).
  • 2017 ACC/AHA-defined elevated DBP was associated only with an increased risk of stroke (aHR, 1.10).

Conclusions:

  • Elevated on-treatment DBP, particularly by the JNC7 definition, poses a significant risk for major cardiovascular events.
  • The 2017 ACC/AHA definition of elevated DBP was primarily associated with an increased risk of stroke.
  • Findings support the importance of monitoring and managing DBP even when SBP targets are achieved, with implications for guideline refinement.
Abstract

Keywords:
Blood pressureHypertension

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