Author + information
- Anita Wokhlu,
- Yan Gong,
- Rhonda Cooper-DeHoff,
- Steven M. Smith,
- Eileen Handberg and
- Carl Pepine
Background: A goal systolic blood pressure (SBP) ≤120mmHg reduced all-cause mortality in older SPRINT patients; however, implications of concomitantly lowering diastolic BP (DBP) with this goal are uncertain.
Methods: 17,131 hypertensive subjects ≥50 yo with CAD were analyzed by SBP category (<110, 110-<120, 120-<130, 130-<140, ≥140 mmHg) and DBP (< or ≥median) per category achieved on treatment. Using National Death Index, long-term all-cause mortality was assessed. To estimate the impact of DBP on mortality risk for each SBP category, multivariate Cox regression analysis adjusting for confounders was performed.
Results: There were 6,031 deaths over 11.6 years of mean follow-up (198,352 patient-years). Median DBP was 66, 72, 76, 78 and 82 mmHg, respectively for the SBP categories. When DBP was <median, mortality rates were higher across all SBP ≥110mmHg categories. Using SBP 120-<130mmHg, DBP ≥76mmHg as reference based on lowest mortality risk, DBP <72mmHg was associated with excess risk in those with SBP 110-<120 mmHg (adjusted HR 1.42; 95% CI 1.21-1.67, p<0.0001). In those with SBP 120-<140mmHg, no association was found between DBP and mortality. In patients with SBP<110 or ≥140mmHg, mortality risk was higher than the referent for DBP < and ≥ median (Figure).
Conclusions: Among older CAD patients, DBP <70-80mmHg is associated with excess mortality when SBP≥110-<120mmHg, but not when SBP≥ 120-<140mmHg. Our findings suggest that the risk of lower DBP with SBP<120mmHg is relevant to reassessing SBP goals.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:00 p.m.-1:10 p.m.
Session Title: New Insights Into Prediction and Treatment of Hypertension
Abstract Category: 33. Prevention: Hypertension
Presentation Number: 1314M-07
- 2017 American College of Cardiology Foundation