Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120-140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials

TLDR: The data suggest at optimal achieved SBP, risk is still defined by low or high DBP, and support guidelines which take DBP at optimal SBP control into consideration.

Abstract: Aims: Current guidelines of hypertensive management recommend upper limits for systolic (SBP) and diastolic blood pressure (DBP). J-curve associations of BP with risk exist for some outcomes suggesting that lower limits of DBP goals may also apply. We examined the association between mean attained DBP and cardiovascular (CV) outcomes in patients who achieved an on-treatment SBP in the range of 120 to 80 mmHg. The associations to outcomes were similar when patients were divided to SBP 120 to < 130 mmHg or 130 to < 140 mmHg for DBP or PP. Conclusion: Compared to a DBP of 70 to < 80 mmHg, lower and higher DBP was associated with a higher risk in patients achieving a SBP of 120 to < 140 mmHg. Associations of DBP and PP to risk were similar notably at controlled SBP. These data suggest at optimal achieved SBP, risk is still defined by low or high DBP. These findings support guidelines which take DBP at optimal SBP control into consideration.