Abstract: FR-PO737
Influence of Baseline Diastolic Blood Pressure (DBP) on the Effects of BP Lowering on All-Cause Mortality: A Meta-Analysis of NIH BP Trials
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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 mortality.
Methods
We conducted a meta-analysis of 5 large NIH BP trials that examined the effects of BP goals on ACM outcomes; SPRINT (N = 9264, SBP goal < 120 vs. < 140 mmHg), ACCORD BP standard glycemia arm (N = 2361, SBP goal < 120 vs. < 140 mmHg), SSPS3 ( N= 3008, SBP goal < 130 vs. < 140 mmHg), MDRD (N=838, SBP goal ≤125 with MAP ≤92 vs SBP ≤ 140 with MAP≤ 107 mmHg) and AASK (N =1094, goal MAP < 92 mmHg vs. 102-107 mmHg). We used DerSimonian-Laird random-effects model in Stata 15.1 version to conduct meta-analyses of the interaction between baseline DBP and the BP intervention on mortality outcomes.
Results
Mean baseline DBP in SPRINT, ACCORD BP, SPS-3, MDRD and AASK were 78 ± 12, 76 ± 10, 78 ± 11, 82 ± 11, and 96 ± 14 mmHg, respectively with evidence of heterogeneity. In the 16,565 participants included in the analysis, there were a total of 989 mortality events over 65,656 total years of follow-up. Intensive BP control resulted in overall lower hazard ratio of ACM events, (HR 0.86, CI 0.75, 0.99) (Table). Lower baseline DBP was associated with increased risk of mortality events (HR 1.19, CI 1.09, 1.30) (Table). The interaction term of baseline DBP and the BP intervention on ACM was non-significant in each of the studies and overall (Figure).
Conclusion
In this meta-analysis of large, multicenter NIH funded trials, BP intervention was beneficial for improving ACM rates, 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 ACM
| Intensive vs Standard BP (HR, CI) | HR per 10 mmHg ↓ in baseline DBP (HR, CI) | |
| SPRINT | 0.81 (0.68, 0.96) | 1.24 (1.14, 1.34) |
| ACCORD-BP | 0.83 (0.60, 1.16) | 1.39 (1.18,1.64) |
| SPS3 | 1.02 (0.77, 1.33) | 1.11 (0.97, 1.27) |
| MDRD | 1.40(0.70, 2.78) | 1.25 (0.92, 1.71) |
| AASK | 0.74 (0.50,1.10) | 1.07 (0.93, 1.23) |
| Overall | 0.86 (0.75,0.99) | 1.19 (1.09, 1.30) |
Funding
- NIDDK Support