Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets
- Author:
Dae-Hee KIM
1
;
In-Jeong CHO
;
Woohyeun KIM
;
Chan Joo LEE
;
Hyeon-Chang KIM
;
Jeong-Hun SHIN
;
Si-Hyuck KANG
;
Mi-Hyang JUNG
;
Chang Hee KWON
;
Ju-Hee LEE
;
Hack Lyoung KIM
;
Hyue Mee KIM
;
Iksung CHO
;
Dae Ryong KANG
;
Hae-Young LEE
;
Wook-Jin CHUNG
;
Kwang Il KIM
;
Eun Joo CHO
;
Il-Suk SOHN
;
Sungha PARK
;
Jinho SHIN
;
Sung Kee RYU
;
Seok-Min KANG
;
Wook Bum PYUN
;
Myeong-Chan CHO
;
Ju Han KIM
;
Jun Hyeok LEE
;
Sang-Hyun IHM
;
Ki-Chul SUNG
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2022;52(6):460-474
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP).
Methods:A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg).
Results:During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort.
Conclusion:Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
