Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets

被引:5
作者
Kim, Dae-Hee [1 ]
Cho, In-Jeong [2 ]
Kim, Woohyeun [3 ]
Lee, Chan Joo [4 ,5 ]
Kim, Hyeon-Chang [4 ,5 ]
Shin, Jeong-Hun [6 ]
Kang, Si-Hyuck [7 ]
Jung, Mi-Hyang [8 ]
Kwon, Chang Hee [9 ]
Lee, Ju-Hee [10 ]
Kim, Hack Lyoung [11 ]
Kim, Hyue Mee [12 ]
Cho, Iksung [4 ,5 ]
Kang, Dae Ryong [13 ]
Lee, Hae-Young [14 ]
Chung, Wook-Jin [15 ]
Kim, Kwang Il [16 ]
Cho, Eun Joo [17 ]
Sohn, Il-Suk [18 ]
Park, Sungha [3 ]
Shin, Jinho [6 ]
Ryu, Sung Kee [19 ]
Kang, Seok-Min [3 ]
Pyun, Wook Bum [2 ]
Cho, Myeong-Chan [10 ]
Kim, Ju Han [20 ]
Lee, Jun Hyeok [21 ]
Ihm, Sang-Hyun [22 ]
Sung, Ki-Chul [23 ]
机构
[1] Univ Ulsan, Asan Med Ctr, Div Cardiol, Coll Med, Seoul, South Korea
[2] Ewha Womans Univ, Seoul Hosp, Coll Med, Dept Internal Med,Div Cardiol, Seoul, South Korea
[3] Korea Univ, Cardiovasc Ctr, Guro Hosp, Seoul, South Korea
[4] Yonsei Univ, Severance Cardiovasc Hosp, Div Cardiol, Coll Med, Seoul, South Korea
[5] Yonsei Univ, Cardiovasc Res Inst, Coll Med, Seoul, South Korea
[6] Hanyang Univ, Dept Internal Med, Div Cardiol, Coll Med, Seoul, South Korea
[7] Seoul Natl Univ, Coll Med, Cardiovasc Ctr, Bundang Hosp, Seongnam, South Korea
[8] Hallym Univ, Dongtan Sacred Heart Hosp, Cardiovasc Ctr, Coll Med, Hwaseong, South Korea
[9] Konkuk Univ, Sch Med, Dept Internal Med, Div Cardiol,Med Ctr, Seoul, South Korea
[10] Chungbuk Natl Univ Hosp, Chungbuk Natl Univ, Dept Internal Med, Div Cardiol,Coll Med, Cheongju, South Korea
[11] Seoul Natl Univ, Dept Internal Med, Seoul Metropolitan Govt, Boramae Med Ctr, Seoul, South Korea
[12] Chung Ang Univ, Chung Ang Univ Hosp, Dept Internal Med, Div Cardiol,Coll Med, Seoul, South Korea
[13] Yonsei Univ, Wonju Coll Med, Dept Precis Med, Wonju, South Korea
[14] Seoul Natl Univ Hosp, Dept Internal Med, Div Cardiol, Seoul, South Korea
[15] Gachon Univ, Gil Hosp, Dept Internal Med, Div Cardiol, Incheon, South Korea
[16] Seoul Natl Univ, Coll Med, Dept Internal Med, Bundang Hosp, Seongnam, South Korea
[17] Catholic Univ Korea, Dept Internal Med, Div Cardiol, Yeouido St Marys Hosp, Seoul, South Korea
[18] Kyung Hee Univ Gangdong, Dept Internal Med, Div Cardiol, Seoul, South Korea
[19] Eulji Med, Dept Internal Med, Div Cardiol, Sch Med, Seoul, South Korea
[20] Chonnam Natl Univ Hosp, Dept Internal Med, Div Cardiol, Gwangju, South Korea
[21] Yonsei Univ, Wonju Coll Med, Dept Biostat, Wonju, South Korea
[22] Catholic Univ Korea, Dept Internal Med, Div Cardiol, Bucheon St Marys Hosp, 327 Sosa Ro, Seoul 14647, South Korea
[23] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Dept Internal Med, Div Cardiol,Sch Med, 29 Saemunan Ro, Seoul 03181, South Korea
关键词
Blood pressure; Hypertension; CORONARY-HEART-DISEASE; YOUNG ADULTHOOD; HYPERTENSION; RISK; ASSOCIATION; MORTALITY; GUIDELINE; STROKE;
D O I
10.4070/kcj.2021.0330
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP >_90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP >_80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05-1.24) but not in those by the 2017 ACC/AHA definition. Elevated on treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18-1.70) and stroke (aHR, 1.19; 95% CI, 1.08-1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04-1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion: Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
引用
收藏
页码:460 / 474
页数:15
相关论文
共 29 条
[1]   Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Disease [J].
Bangalore, Sripal ;
Guo, Yu ;
Samadashvili, Zaza ;
Blecker, Saul ;
Xu, Jinfeng ;
Hannan, Edward L. .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (13) :1213-1222
[2]   ISOLATED ELEVATION OF DIASTOLIC BLOOD-PRESSURE - REAL OR ARTIFACTUAL [J].
BLANK, SG ;
MANN, SJ ;
JAMES, GD ;
WEST, JE ;
PICKERING, TG .
HYPERTENSION, 1995, 26 (03) :383-389
[3]   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 [J].
Boehm, Michael ;
Schumacher, Helmut ;
Teo, Koon K. ;
Lonn, Eva ;
Mahfoud, Felix ;
Mann, Johannes F. E. ;
Mancia, Giuseppe ;
Redon, Josep ;
Schmieder, Roland ;
Weber, Michael ;
Sliwa, Karen ;
Williams, Bryan ;
Yusuf, Salim .
EUROPEAN HEART JOURNAL, 2018, 39 (33) :3105-3114
[4]   Reconsidering the cut-off diastolic blood pressure for predicting cardiovascular events: a nationwide population-based study from Korea [J].
Choi, You-Jung ;
Kim, Sun-Hwa ;
Kang, Si-Hyuck ;
Yoon, Chang-Hwan ;
Lee, Hae-Young ;
Youn, Tae-Jin ;
Chae, In-Ho ;
Kim, Cheol-Ho .
EUROPEAN HEART JOURNAL, 2019, 40 (09) :724-+
[5]   ISOLATED DIASTOLIC HYPERTENSION - A FAVORABLE FINDING AMONG YOUNG AND MIDDLE-AGED HYPERTENSIVE SUBJECTS [J].
FANG, J ;
MADHAVAN, S ;
COHEN, H ;
ALDERMAN, MH .
HYPERTENSION, 1995, 26 (03) :377-382
[6]   Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes [J].
Flint, Alexander C. ;
Conell, Carol ;
Ren, Xiushui ;
Banki, Nader M. ;
Chan, Sheila L. ;
Rao, Vivek A. ;
Melles, Ronald B. ;
Bhatt, Deepak L. .
NEW ENGLAND JOURNAL OF MEDICINE, 2019, 381 (03) :243-251
[7]  
Franklin SS, 2001, CIRCULATION, V103, P1245
[8]   The importance of diastolic blood pressure in predicting cardiovascular risk [J].
Franklin, Stanley S. .
JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION, 2007, 1 (01) :82-93
[9]   Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:: principal results of the hypertension optimal treatment (HOT) randomised trial [J].
Hansson, L ;
Zanchetti, A ;
Carruthers, SG ;
Dahlöf, B ;
Elmfeldt, D ;
Julius, S ;
Ménard, J ;
Rahn, KH ;
Wedel, H ;
Westerling, S .
LANCET, 1998, 351 (9118) :1755-1762
[10]   Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home -: The Ohasama Study [J].
Hozawa, A ;
Ohkubo, T ;
Nagai, K ;
Kikuya, M ;
Matsubara, M ;
Tsuji, I ;
Ito, S ;
Satoh, H ;
Hisamichi, S ;
Imai, Y .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (21) :3301-3306