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KMID : 0368120220520060460
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Korean Circulation Journal
2022 Volume.52 No. 6 p.460 ~ p.474
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Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets
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Kim Dae-Hee
Cho In-Jeong
Kim Woo-Hyeun
Lee Chan-Joo
Kim Hyeon-Chang
Shin Jeong-Hun
Kang Si-Hyuck
Jung Mi-Hyang
Kwon Chang-Hee
Lee Ju-Hee
Kim Hack-Lyoung
Kim Hyue-Mee
Cho Ik-Sung
Kang Dae-Ryong
Lee Hae-Young
Chung Wook-Jin
Kim Kwang-Il
Cho Eun-Joo
Sohn Il-Suk
Park Sung-Ha
Shin Jin-Ho
Ryu Sung-Kee
Kang Seok-Min
Pyun Wook-Bum
Cho Myeong-Chan
Kim Ju-Han
Lee Jun-Hyeok
Ihm Sang-Hyun
Sung Ki-Chul
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Abstract
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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.
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KEYWORD
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Blood pressure, Hypertension
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