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Diastolic blood pressure and risk profile in renal and cardiovascular diseases. Results from the sprint trial
Journal of the American Society of Hypertension Pub Date : 2018-05-05
Rita Del Pinto, Davide Pietropaoli, Claudio Ferri

Objective

The 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 and chronic kidney disease. We evaluated the risk of events in SPRINT with focus on these subgroups according to DBP.

Methods

Mean DBP (±SD) throughout follow-up time was calculated for each patient. Patients were then categorized into 5 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.

Results

A higher risk for cardiovascular events was observed in the lower DBP range overall (HR 1.46, C.I.95% 1.1–1.95, p<0.001), but not in the absence of pre-existing cardiovascular or renal disease. Indeed, such risk significantly increased above 80 mmHg in patients with cardiovascular 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.

Conclusions

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:

肾脏和心血管疾病的舒张压和风险状况。冲刺试验的结果

客观的

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可以达到安全性和安全性。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疾病和慢性肾脏疾病的受试者中。我们根据DBP评估了这些亚组中SPRINT事件发生的风险。

方法

计算每位患者在整个随访期间的平均DBP(±SD)。然后根据平均DBP将患者分为5组(<60 mmHg,60–69 mmHg,70–79 mmHg [参考],80–89 mmHg,≥90mmHg);结果的危险比在总体上和在预定的亚组中进行了评估。

结果

总体而言,在较低的DBP范围内观察到发生心血管事件的风险较高(HR 1.46,CI95%1.1–1.95,p <0.001),但在不存在先前存在的心血管疾病或肾脏疾病的情况下则没有。确实,对于某些结局,这种风险在心血管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。

结论

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。

更新日期:2018-05-05
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