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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Influence of baseline diastolic blood pressure on effects of intensive compared with standard blood pressure control
Circulation, Volume 137, No. 2, Year 2018
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Description
Background: In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear. Methods: SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target <120 mm Hg) and standard (target <140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP. Results: Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level (P for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction P value of 0.78. Results were similar for all-cause death and kidney events. Conclusions: Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP. © 2018 American Heart Association, Inc.
Authors & Co-Authors
Chertow, Glenn Matthew
United States, Salt Lake City
University of Utah School of Medicine
United States, Palo Alto
Stanford University
Cushman, William C.
United States, Memphis
Memphis va Medical Center
Rahman, Mahboob Omar
United States, Cleveland
Case Western Reserve University
Campbell, Ruth C.
United States, Charleston
Medical University of South Carolina
Freedman, Barry I.
Unknown Affiliation
Kitzman, Dalane W.
Unknown Affiliation
Pisoni, Roberto
United States, Charleston
Medical University of South Carolina
United States, Charleston
Ralph H. Johnson va Medical Center
Rosendorff, Clive
United States, New York
Icahn School of Medicine at Mount Sinai
Watnick, Suzanne G.
United States, Portland
Oregon Health & Science University
Whelton, Paul Kieran
United States, New Orleans
Tulane University School of Public Health and Tropical Medicine
Statistics
Citations: 120
Authors: 10
Affiliations: 17
Identifiers
Doi:
10.1161/CIRCULATIONAHA.117.030848
ISSN:
00097322
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Randomised Control Trial
Study Approach
Quantitative