Does low on-treatment DBP increase cardiovascular risk in the SPRINT population?
Low on-treatment diastolic blood pressure does not independently increase cardiovascular risk when achieving systolic blood pressure targets.
Recent studies including the SPRINT trial have shown beneficial effects of intensive systolic blood pressure reduction over the standard approach. The awareness of the J-curve for diastolic blood pressure (DBP) causes some uncertainty regarding the net clinical effects of blood pressure reduction. The current analysis was performed to investigate effects of low on-treatment DBP on cardiovascular risk in the SPRINT population. The primary composite outcome was the occurrence of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. The prevalence of primary outcomes was significantly higher in subjects within low DBP in both standard (44-67 mmHg 10.8% vs 67-73 mmHg 6.7% vs 73-78 mmHg 5.1% vs 78-83 mmHg 4.4% vs 83-113 mmHg 4.3%, p < 0.001) and intensive treatment (38-61 mmHg 6.7% vs 61-66 mmHg 4.1% vs 66-70 mmHg 4.5% vs 70-74 mmHg 2.7% vs 74-113 mmHg 3.4%, p < 0.001) arms. After adjusting for covariates, low DBP showed no significant effects on cardiovascular risk. Therefore, while reaching blood pressure targets, low DBP should not be a matter of concern.
Sobieraj et al. (Tue,) studied this question.