Intensive Blood Pressure Lowering in Individuals With Low Diastolic Blood Pressure and Elevated Troponin Levels in
Cady Smith1, Jarett D Berry2, Rebecca Scherzer3
1Department of Internal Medicine University of California Davis Sacramento CA USA.
Insights
Intensive blood pressure (BP) lowering benefits patients with hypertension, regardless of diastolic BP or high-sensitivity cardiac troponin T (hs-cTnT) levels. This approach effectively reduces cardiovascular disease risk and mortality across diverse patient subgroups.
Area of Science:
- Cardiology
- Hypertension Management
- Biomarkers in Cardiovascular Disease
Background:
- Optimal blood pressure (BP) targets for hypertensive individuals with low diastolic BP (DBP) are debated.
- Concerns exist that aggressive BP reduction may compromise coronary perfusion in these patients.
Purpose of the Study:
- To investigate the impact of intensive BP control on cardiovascular outcomes.
- To assess intensive BP control in patients with elevated systolic BP, low DBP, and elevated high-sensitivity cardiac troponin T (hs-cTnT) levels.
Main Methods:
- Analysis of 8828 participants from the Systolic Blood Pressure Intervention Trial (SPRINT).
- Stratification of participants by baseline DBP (<70 mmHg vs. ≥70 mmHg) and hs-cTnT levels (≥14 ng/L vs. <14 ng/L).
- Comparison of intensive vs. standard BP lowering on cardiovascular composite endpoints, all-cause death, and hs-cTnT changes.
Main Results:
- Low DBP with high hs-cTnT was linked to increased cardiovascular disease and all-cause death risk.
- Intensive BP lowering yielded similar cardiovascular disease risk reductions across groups: low DBP/high hs-cTnT, low DBP/low hs-cTnT, and DBP ≥70 mmHg.
- All-cause death reduction was also similar across these subgroups with intensive BP lowering.
Conclusions:
- Individuals with low DBP and elevated hs-cTnT, low DBP and normal hs-cTnT, or DBP ≥70 mmHg experienced comparable benefits from intensive BP lowering.
- These findings suggest intensive BP lowering is beneficial across these subgroups, but require further confirmation.
Background:
Among individuals with hypertension and low diastolic blood pressure (DBP), the optimal BP target remains controversial due to concerns that BP lowering may reduce coronary perfusion. We determined the impact of intensive BP control among individuals with elevated systolic BP who have low DBP and elevated hs-cTnT (high-sensitivity cardiac troponin T) levels.
Methods And Results:
A total of 8828 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were stratified by baseline DBP. Those with low DBP (<70 mm Hg) were further stratified by elevated hs-cTnT (≥14 ng/L) at baseline. The effects of intensive versus standard BP lowering on a cardiovascular disease composite end point, all-cause death, and 1-year change in hs-cTnT were determined. The combination of low DBP/high hs-cTnT was independently associated with a higher risk for cardiovascular disease and all-cause death, as well as greater 1-year increases in hs-cTnT, compared with DBP ≥70 mm Hg. However, randomization to intensive versus standard BP lowering led to similar reductions in cardiovascular disease risk among individuals with low DBP/high hs-cTnT (hazard ratio [HR], 0.82 [95% CI, 0.57-1.19]), low DBP/low hs-cTnT (HR, 0.48 [95% CI, 0.29-0.79]), and DBP ≥70 mm Hg (HR, 0.73 [95% CI, 0.60-0.89]; P for interaction=0.20). Intensive BP lowering also led to a reduction in all-cause death that was similar across groups (P for interaction=0.57).
Conclusions:
In this nonprespecified subgroup analysis of SPRINT, individuals with low DBP and elevated hs-cTnT, low DBP and nonelevated hs-cTnT, and DBP ≥70 mm Hg derived similar cardiovascular disease and mortality benefits from intensive BP lowering. These findings warrant confirmation in other studies.
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