Flint AC, et al. - Since recently revised blood pressure guidelines with two different thresholds (≥140/90 mm Hg and ≥130/80 mm Hg) for treating hypertension has complicated the relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes, researchers evaluated the impact of elevated systolic and diastolic blood pressure on cardiovascular outcomes. Both systolic and diastolic hypertension independently affected the risk of adverse cardiovascular events, despite of the definition of hypertension, however, the systolic blood-pressure increase had a greater influence.

Methods

• To ascertain the impact of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years, a multivariable Cox survival analysis was carried out using data from 1.3 million adults in a general outpatient population.
• Demographic features and coexisting conditions were controlled by the analysis.

Results

• Adverse outcomes were independently prognosticated by each of the burdens of systolic and diastolic hypertension.
• The composite outcome was independently prognosticated by a continuous burden of systolic hypertension (≥140 mm Hg; hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI], 1.17 to 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07) in survival models.
• Without hypertension thresholds, comparable outcomes were discovered when the lower threshold of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors.
• Amongst individuals in the lowest quartile of diastolic blood pressure, a J-curve association between diastolic blood pressure and outcomes was seen that was clarified at least in part by age and other covariates and by a higher impact of systolic hypertension.