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

Dae Hee Kim, 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 ParkJinho 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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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 on-treatment 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.

Original languageEnglish
Article numbere31
JournalKorean Circulation Journal
Volume52
DOIs
StatePublished - 2022

Keywords

  • Blood pressure
  • Hypertension

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