Anew study has found that regardless of whether systolic blood pressure (SBP) is controlled, diastolic blood pressure (DBP) still affects cardiovascular (CV) outcomes, including myocardial infarction and hospitalization.
The researchers came to this conclusion after assessing data from 31,546 patients aged 55 years or older with CV disease who were participating in the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease) trials. During the trials, patients were randomly assigned to ramipril, telmisartan, or the combination.
The primary outcome was achievement of an on-treatment SBP of 120 to 140 mmHg.
Overall, 16,099 (51%) participants achieved the primary outcome of controlled SBP. Participants exhibited the lowest risk for any CV outcome at an achieved DBP of 70 to 80 mmHg.
Participants with a DBP of 70 mmHg or lower were more likely to achieve the primary outcome of controlled SBP than their peers with higher DBP. However, they were also likely to experience myocardial infarction, hospitalization for heart failure, and all-cause mortality.
Stroke and CV mortality were not associated with a DBP of 70 to 80 mmHg.
Participants with a DBP of 80 mmHg or higher had a higher risk for stroke and hospitalization for heart failure, and those with a DBP of 90 mmHg or more had a higher risk for myocardial infarction.
“Compared to a DBP of 70 to <80 mmHg, lower and higher DBP was associated with a higher risk in patients achieving [an] SBP of 120 to <140 mmHg,” the researchers concluded. “Associations of DBP and PP to risk were similar notably at controlled SBP. These data suggest at optimal achieved SBP, risk is still defined by low or high DBP. These findings support guidelines which take DBP at optimal SBP control into consideration.”
Böhm M, Schumacher H, Teo KK, et al. Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120–140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Eur Heart J. 2018;39(33):3105-3114.https://doi.org/10.1093/eurheartj/ehy287.