Lower achieved SBP and DBP associated with more CV events

Main results

• The lowest risk for the combined primary outcome as well as CV death, hospital admission for HF and all-cause death, was seen at a baseline SBP of 120-140 mmHg. Those with SBP >140 mmHg or SBP <120 mmHg had higher event rates for stroke and MI.
• The risk was highest at a baseline DBP <70 mmHg for all outcomes except stroke.
• Patients with a baseline SBP of 140–160 mmHg and ≥160 mmHg had significantly higher event rates for all outcomes except MI, for which the risk was only increased at SBP ≥160 mmHg.
• DBP ≥90 mmHg at baseline was associated with a lower risk for the composite outcome, MI, and hospital admission for HF compared with all lower DBP values.
• DBP <70 mmHg at baseline was associated with higher rates of all outcomes except stroke.
• For the mean achieved SBP values during treatment, the lowest level of risk occurred at SBP of 120–140 mmHg for all outcomes except MI.
• For the combined primary outcome, CV death, hospital admission for HF and all-cause death, there was an increased risk at an SBP <120 mmHg during treatment.
• For the primary outcome, all its components, and all-cause death, an increased risk was observed at SBPs of 140–160 mmHg and >160 mmHg.
• Similar patterns were observed with DBP.
• Analysis taking SBP as a continuous variable and using cubic spline regression revealed that the relationship between endpoints and baseline SBP (and achieved SBP) were non-linear. The risk for the primary outcome increased from a mean achieved SBP of 140 mmHg to lower SBP values. Similar results were observed for the other outcomes except for MI and stroke.
• Regarding HRs for outcomes in different baseline SBP groups according to range of SBP changes on treatment, in which no change was reference (HR=1), the risk for the primary outcome increased with SBP reduction, when baseline SBP was <120 mmHg. Furthermore, for participants with a baseline SBP of 140-160 mmHg, reduction of SBP up to 30 mmHg was associated with reduced risk for the primary outcome, which was 50 mmHg reduction when baseline SBP was ≥160 mmHg.

Conclusion

References

Find this article online at The Lancet