Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
The contribution of low DBP to cardiovascular risk in ischemic stroke patients with 3 SBP targted levels (﹤120, ﹤130, ﹤140mmHg)
First author：Zimo Chen
Corresponding author：Yongjun Wang
essential_information
2020-05-27
Published articles
Journal：Frontiers in Neurology
Publication type: Original Contributions
IF(IF): 4.003
PMID: 32536899 Link To Pubmed Full text Download
Background And Purpose
Previously, SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated that compared with less than 140 mm Hg, targeting a systolic blood pressure (SBP) of less than 120 mm Hg of patients at high risk for cardiovascular events resulted in lower rates of major cardiovascular events. Moreover, the recently announced 2017 ACC/AHA guideline redefined the hypertension to adopt lower BP criteria, from the previous 140/90mmHg to 130/80mmHg. However, it’s also worth noting that to obtain intensive SBP reductions will inevitably lower DBP. Furthermore, this is of potential concern due to the known J-curve for DBP and cardiovascular events. There is, however, a paucity of evidence on the effect of DBP level on adverse events among stroke patients. The aim of the current study is to examine whether low DBP under different SBP targeted levels increase the risk of cardiovascular events and stroke recurrence among stroke patients.
Method
Multivariable Cox regression analyses were used to evaluate the relationship between DBP category and the outcomes and multivariable-adjusted hazard ratio (HR) with their 95% confidence intervals (CI) for clinical outcomes.
Conclusion
Along with the new target levels of SBP suggested by updated criteria, there is a trend for DBP to be reduced to a harmfully low level, which was associated with an increased risk of cardiac events among patients with IS or TIA.
Main results
During 1 year of follow-up, a total of 95 cardiac events and 138 stroke recurrences were identified. The patients with low DBP showed a significantly higher risk of cardiac events (hazard ratio [HR]=4.86, 95% confidence interval [CI]=2.54–8.52), especially the elderly patients (≥60 years); however, this result was not observed for stroke recurrence (HR=0.90, 95% CI=0.46–1.74). With the reduction of the SBP levels, the proportion of patients with low DBP increased (6.87%, 12.67%, 34.46%, respectively) and the risk for cardiac events persisted.