The Systolic Blood Pressure Intervention Trial (SPRINT) trial demonstrated the efficacy and safety of targeting a systolic blood pressure of <120 mmHg compared to <140 mmHg in selected hypertensive patients. Some evidence, however, suggests a J-curve for; diastolic blood pressure (DBP) particularly in subjects with cardiovascular (CV) and chronic kidney disease. We evaluated the risk of events in SPRINT with focus on these subgroups according to DBP. Mean DBP (±standard deviation) throughout follow-up time was calculated for each patient. Patients were then categorized into five groups according to mean DBP (<60 mmHg, 60-69 mmHg, 70-79 mmHg [reference], 80-89 mmHg, ≥90 mmHg); hazard ratio for outcomes was assessed overall and in the predefined subgroups. A higher risk for CV events was observed in the lower DBP range overall (hazard ratio 1.46, confidential interval 95% 1.1-1.95, P < .001), but not in the absence of pre-existing CV or renal disease. Indeed, such risk significantly increased above 80 mmHg in patients with CV disease and below 70 mmHg in those with chronic kidney disease for selected outcomes. DBP<70 mmHg particularly affected renal outcomes irrespective of renal status. Different risk profiles according to DBP appear to be related to specific clinical characteristics in SPRINT. These findings require further testing in dedicated trials with appropriate follow-up.

中文翻译：

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肾脏和心血管疾病的舒张压和风险状况。SPRINT试验的结果。

收缩压干预试验（SPRINT）试验证明，在选定的高血压患者中，将收缩压<120 mmHg相对于<140 mmHg的目标是有效和安全的。但是，一些证据表明存在J曲线。舒张压（DBP），尤其是在患有心血管（CV）和慢性肾脏疾病的受试者中。我们根据DBP评估了SPRINT中事件的风险，重点是这些亚组。计算每位患者在整个随访期间的平均DBP（±标准差）。然后根据平均DBP将患者分为五组（<60 mmHg，60-69 mmHg，70-79 mmHg [参考]，80-89 mmHg，≥90mmHg）；总体和预定义的亚组评估结果的危险比。总体而言，在较低的DBP范围内观察到CV事件的风险较高（危险比1.46，机密区间95％1.1-1.95，P <.001），但在不存在既往的CV或肾脏疾病的情况下则没有。的确，对于某些结局，这种风险在CV疾病患者中明显高于80 mmHg，而在慢性肾脏疾病患者中则低于70 mmHg。不论肾脏状况如何，DBP <70 mmHg都会特别影响肾脏预后。根据DBP的不同风险特征似乎与SPRINT中的特定临床特征有关。这些发现需要在专门的试验中进行进一步的测试，并进行适当的随访。对于某些结果，这种风险在CV疾病患者中显着增加到80 mmHg以上，而在慢性肾脏疾病患者中则降低到70 mmHg以下。不论肾脏状况如何，DBP <70 mmHg都会特别影响肾脏预后。根据DBP的不同风险特征似乎与SPRINT中的特定临床特征有关。这些发现需要在专门的试验中进行进一步的测试，并进行适当的随访。对于某些结果，这种风险在CV疾病患者中显着增加到80 mmHg以上，而在慢性肾脏疾病患者中则降低到70 mmHg以下。不论肾脏状况如何，DBP <70 mmHg都会特别影响肾脏预后。根据DBP的不同风险特征似乎与SPRINT中的特定临床特征有关。这些发现需要在专门的试验中进行进一步的测试，并进行适当的随访。