Bohm M, et al. - Experts evaluated the correlation between mean attained diastolic blood pressure (DBP) and cardiovascular (CV) outcomes in patients who attained an on-treatment systolic blood pressure (SBP) in the range of 120 to < 140 mmHg in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND) trials with high CV risk. Findings suggested a link of lower and higher DBP to a higher risk in patients achieving a SBP of 120 to < 140 mmHg vs a DBP of 70 to < 80 mmHg. At controlled SBP, a relationship of DBP and PP with risk was similar. Low or high DBP still defines risk, suggested by the results at optimal achieved SBP. Guidelines that take DBP at optimal SBP control into consideration were supported.

Methods

• Researchers evaluated outcome data from patients 55 years or older with CV disease from the ONTARGET and TRANSCEND trials, which randomized high-risk patients to ramipril, telmisartan, and the combination.
• In patients with controlled SBP (on-treatment 120 to < 140mmHg), they analyzed the composite outcome of CV death, myocardial infarction, stroke and hospital admission for heart failure, the components thereof, and all-cause mortality according to mean on-treatment DBP as categorical (<70, 70 to < 80, 80 to < 90, and ≥90 mmHg) and continuous variable, as well as the change of DBP according to baseline DBP.
• The relationship of pulse pressure (PP) with outcomes as a continuous variable was assessed.

Results

• Findings suggested that mean achieved SBP in 16,099 of 31,546 patients was 120 to <140 mmHg.
• As per data, at an achieved DBP of 70 to <80 mmHg, the nominally lowest risk for all outcomes was seen.
• Results demonstrated a link between a higher achieved DBP and a higher risk for the outcomes of stroke and of hospitalization for heart failure (≥ 80 mmHg) and myocardial infarction (≥ 90 mmHg).
• Data suggested a link between a lower achieved DBP (< 70 mmHg) with a higher risk for the primary outcome (hazard ratio [HR] 1.29, 95% confidence interval [95% CI] 1.15–1.45; P < 0.0001), myocardial infarction HR 1.54 (95% CI 1.26–1.88, P < 0.0001), hospitalization for heart failure HR 1.81 (95% CI 1.47–2.24, P < 0.0001), and all-cause death (HR 1.19, 95% CI 1.04–1.35;P < 0.0001) while there was no signal for stroke and CV death compared to DBP 70 to < 80 mmHg.
• Researchers noted that a decrease of DBP was related to lower risk when baseline DBP was > 80 mmHg.
• They noted similar associations to outcomes when patients were divided to SBP 120 to < 130 mmHg or 130 to < 140 mmHg for DBP or PP.