Low diastolic BP at optimal systolic BP may be associated with cardiovascular outcomes

Takeaway

• Compared to a diastolic BP (DBP) of 70 to <80 mmHg, lower and higher DBP was associated with increased risk for myocardial infarction (MI), hospitalisation for heart failure and all-cause death among patients achieving a systolic BP (SBP) of 120 to <140 mmHg.

Why this matters

• Current international guidelines recommend a target BP of less than 140/90 mmHg to reduce cardiovascular outcomes.
• Guidelines should take into consideration lower boundaries of achieved on-treatment SBP, DBP, and DBP even at optimal SBP.

Study design

• Retrospective observational study of 16,099 patients with cardiovascular disease from Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND) trials.
• Primary outcome was a composite of cardiovascular death, non-fatal MI, stroke, or hospitalization for heart failure.
• Funding: None disclosed.

Key results

• Patients with DBP of 70 to <80 mmHg experienced the lowest risk for cardiovascular outcomes.
• High DBP of ≥80 mmHg was associated with higher risk for stroke and hospitalisation for heart failure, and ≥90 mmHg was associated with risk for MI.
• Low DBP (<70 mmHg) was associated with increased risk for primary outcome (HR, 1.29; P<.0001), MI (HR, 1.54; P<.0001), hospitalisation for heart failure (HR, 1.81; P<.0001) and all-cause death (HR, 1.19; P<.0001).
• Risk for cardiovascular events was lowest when SBP was 120 to <130 mmHg vs 130 to <140 mmHg.

Limitations

• Reverse causality could not be ruled out or proved.