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

Authors
 Dae-Hee Kim  ;  In-Jeong Cho  ;  Woohyeun Kim  ;  Chan Joo Lee  ;  Hyeon-Chang Kim  ;  Jeong-Hun Shin  ;  Si-Hyuck Kang  ;  Mi-Hyang Jung  ;  Chang Hee Kwon  ;  Ju-Hee Lee  ;  Hack Lyoung Kim  ;  Hyue Mee Kim  ;  Iksung Cho  ;  Dae Ryong Kang  ;  Hae-Young Lee  ;  Wook-Jin Chung  ;  Kwang Il Kim  ;  Eun Joo Cho  ;  Il-Suk Sohn  ;  Sungha Park  ;  Jinho Shin  ;  Sung Kee Ryu  ;  Seok-Min Kang  ;  Wook Bum Pyun  ;  Myeong-Chan Cho  ;  Ju Han Kim  ;  Jun Hyeok Lee  ;  Sang-Hyun Ihm  ;  Ki-Chul Sung 
Citation
 KOREAN CIRCULATION JOURNAL, Vol.52(6) : 460-474, 2022-06 
Journal Title
KOREAN CIRCULATION JOURNAL
ISSN
 1738-5520 
Issue Date
2022-06
Keywords
Blood pressure ; Hypertension
Abstract
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.
Files in This Item:
T9992023143.pdf Download
DOI
10.4070/kcj.2021.0330
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
Cho, Ik Sung(조익성)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/194485
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