Abstract: FR-PO538

Influence of Baseline Diastolic Blood Pressure (DBP) Level on the Effects of Intensive Blood Pressure Lowering on Cardiovascular (CV) Outcome in SPRINT

Session Information

Category: Hypertension

  • 1104 Hypertension: Clinical and Translational - Salt and Hypertension

Authors

  • Beddhu, Srini, Univ Utah, SLC, Utah, United States
  • Chertow, Glenn Matthew, Stanford Univ, Palo Alto, California, United States
  • Cheung, Alfred K., Univ Utah, SLC, Utah, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Greene, Tom, Univ Utah, SLC, Utah, United States
  • Wei, Guo, Univ Utah, SLC, Utah, United States
  • Haley, William E., Mayo Clinic, Jacksonville, Florida, United States
  • Cushman, William C., VAMC, Memphis, Tennessee, United States
  • Whelton, Paul K., Tulane Univ, New Orleans, Louisiana, United States

Group or Team Name

  • For SPRINT Research Group
Background

Lowering systolic blood pressure (SBP) in persons with low DBP might affect tissue perfusion and thereby, ↑ risk for CV events.

Methods

SPRINT tested the effects of SBP goal < 120 vs. < 140 mm Hg on CV outcomes in 9361 participants. We tested for effect modification by baseline DBP of the intervention on primary CV outcome (a composite of non-fatal MI, ACS not resulting in MI, stroke, CHF, or CV death).

Results

Mean age was 67.9 ± 9.4 years, with 35.6 % being women and 31.5 % Black. Means (± SD) baseline SBP and DBP were 139.7 ± 15.6 and 78.1 ± 11.9 mm Hg, respectively. There were 562 primary outcome events over 29,277 person-years of follow-up. Adjusted for age, gender, race and the intervention arm, baseline DBP had a U-shaped association with the primary outcome (figure, panel A). Intensive SBP treatment reduced the risk of the primary outcome vs. standard treatment (hazard ratio [HR] 0.76, 95% CI 0.64 to 0.89). P-value for the linear treatment by baseline DBP interaction did not approach statistical significance for the primary outcome (p = 0.85). HR for primary outcome across DBP quintiles are summarized in figure, panel B. HR for the primary outcome was 0.78 (95% CI 0.57 to 1.07) within the lowest DBP quintile and 0.74 (95% CI 0.61 to 0.90) within the upper four DBP quintiles (interaction p-value = 0.78).

Conclusion

While baseline low DBP was associated with increased risk of CV events, there is no evidence that the beneficial effects of the SPRINT intervention were modified by the level of baseline DBP.

Funding

  • NIDDK Support