59 Diastolic blood pressure, subclinical myocardial damage, and cardiac events: implications for blood pressure control

Abstract

Background The optimal systolic blood pressure (SBP) treatment goal is in question, with SPRINT (Systolic Blood Pressure Intervention Trial) suggesting benefit for 120 mm Hg. However, achieving an SBP this low may reduce diastolic blood pressure (DBP) to levels that could compromise myocardial perfusion. Objectives This study sought to examine the association of DBP with prevalent and progressive myocardial damage (using high-sensitivity cardiac Troponin-T, hs-cTnT). We also examined prospective associations between DBP and coronary heart disease (CHD), stroke, or death over 21 years; overall and stratified by subgroups of interest. Methods We studied 11,565 adults from the Atherosclerosis Risk in Communities (ARIC) study. We evaluated cross-sectional DBP and hs-cTnT (dichotomized at 14 ng/L) associations with logistic regression, longitudinal associations between DBP and hs-cTnT change using generalised linear models adjusted for attrition, and prospective associations between DBP and events with Cox regression. Results Mean baseline age was 57 years, 57% of patients were female, and 25% were black. Compared with persons who had DBP between 80 to 89 mm Hg at baseline (ARIC visit 2), the adjusted odds ratio of having hs-cTnT ≥14 ng/l at that visit was 2.2 [95% CI: 1.2–4.1] and 1.5 [1.0–2.3] in those with DBP Conclusions Particularly among adults with an SBP ≥120 mm Hg, and thus elevated pulse pressure, low DBP was associated with subclinical myocardial damage and CHD events. When titrating treatment to SBP