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Abstract: TH-OR23

Influence of Baseline Diastolic BP (DBP) on the Effects of BP Lowering on Cardiovascular (CV) Outcomes: A Meta-Analysis of NIH BP Trials

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

  • Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
  • Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
  • Ye, Xiangyang, University of Utah Health, Salt Lake City, Utah, United States
  • Shen, Jincheng, University of Utah Health, Salt Lake City, Utah, United States
  • Chertow, Glenn, Stanford University School of Medicine, Stanford, California, United States
  • Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
Background

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

Methods

We conducted a meta-analysis of 4 NIH BP trials that examined the effects of BP goals on CV outcomes; SPRINT, N = 9247, SBP goal < 120 vs. < 140), ACCORD BP standard glycemia arm (N = 2361, SBP goal < 120 vs. < 140), SPS3 ( N= 3008, SBP goal < 130 vs. < 140) and AASK (N =1094, goal MAP < 92 mmHg vs. 102-107). We used DerSimonian-Laird random-effects models in Stata version 15.1 to conduct meta-analyses of the interaction between baseline DBP and the BP intervention on CV outcomes.

Results

Mean baseline DBP in SPRINT, ACCORD BP, SPS-3 and AASK were 78 ± 12, 76 ± 10, 78 ± 11, 96 ± 14 mmHg, respectively with evidence of heterogeneity. In the 15,710 participants included, there were 1614 CV events over 59,925 person-years of follow-up. Intensive BP control resulted in overall lower hazard of CV events, (HR 0.79, CI 0.72, 0.87) (Table). Lower baseline DBP was associated with increased risk of CV events in SPRINT and ACCORD BP but not in SPS3 and AASK with a non-significant association of lower DBP with CV events (HR 1.10, CI 0.97, 1.24) (Table). The interaction term of baseline DBP and the BP intervention on CV events was non-significant in each of the studies and pooled overall (Figure).

Conclusion

In this meta-analysis of large, multicenter NIH-funded trials, BP intervention was beneficial for improving CV outcomes, but there was no evidence that these beneficial effects were modified by baseline DBP.

Effects of BP intervention on and the associations of baseline DBP with CV events
 Intensive vs Standard BP (HR, CI)HR per 10 mmHg ↓ in baseline DBP (HR, CI)
SPRINT0.76 (0.65, 0.88)1.20 (1.12, 1.28)
ACCORD-BP0.76 (0.62, 0.94)1.24 (1.11, 1.37)
SPS30.86 (0.70, 1.06)1.02 (0.92, 1.12)
AASK0.90 (0.65, 1.24)0.95 (0.85, 1.06)
Overall0.79 (0.72, 0.87)1.10 (0.97, 1.24)

Funding

  • NIDDK Support