Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials

BMC Medicine

Zhixin Jiang¹  Kangyu Chen²  Tao Chen³  Chao Li⁴  Guoshuai Shi⁴  Zhenqiang Wu⁵  Vicky Watson⁶  Xiaodan Yuan⁷  Hui Mai⁸  Duolao Wang⁹  Tian Yang^1,10  Rui Shi^1,11 

[1] Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital;Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China;Department of Clinical Sciences, Liverpool School of Tropical Medicine;Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Centre;Department of Geriatric Medicine, The University of Auckland;Department of Health Data Sciences, Institute of Population Health, The University of Liverpool;Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine;Department of Neurology, Central People’s Hospital of Zhanjiang;Department of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University;Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University;Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service Foundation Trust, National Heart and Lung Institute, Imperial College London;

关键词: Blood pressure;    Diabetes mellitus;    Cardiovascular disease;    Pharmaceutical treatment;    Propensity score;   

DOI  :  10.1186/s12916-022-02407-z

来源: DOAJ

【 摘 要 】

Abstract Background Recent guidelines recommended a systolic blood pressure (SBP) target of < 130 mmHg for patients with or without diabetes but without providing a lower bound. Our study aimed to explore whether additional clinical benefits remain at achieved blood pressure (BP) levels below the recommended target. Methods We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) among the non-diabetic population and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial among diabetic subjects. We used the propensity score method to match patients from the intensive BP group to those from the standard group in each trial. Individuals with different achieved BP levels from the intensive BP group were used as “reference.” For each stratum, the trial-specific primary outcome (i.e., composite outcome of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure (HF), or cardiovascular death for SPRINT; non-fatal MI, non-fatal stroke, or cardiovascular death for ACCORD-BP) was compared by Cox regression. Results A non-linear association was observed between the mean achieved BP and incidence of composite cardiovascular events, regardless of treatment allocation. The significant treatment benefit for primary outcome remained at SBP 110–120 mmHg (hazard ratio, 0.59 [95% CI, 0.46, 0.76] for SPRINT; 0.67 [0.52, 0.88] for ACCORD-BP) and SBP 120–130 mmHg for SPRINT (0.47 [0.34, 0.63]) but not for ACCORD-BP (0.93 [0.70, 1.23]). The results were similar for the secondary outcomes including all-cause mortality, cardiovascular mortality, MI, stroke, and HF. Intensive BP treatment benefits existed among patients maintaining a diastolic BP of 60–70 mmHg but were less distinct. Conclusions The treatment benefit persists at as low as SBP 110–120 mmHg irrespective of diabetes status. Achieved very low BP levels appeared to increase cardiovascular events and all-cause mortality.

【 授权许可】

Unknown