Should BP Be Lowered in Isolated Diastolic Hypertension?

METHODOLOGY:

Researchers pooled data from 51 randomized clinical trials and conducted an individual participant data meta-analysis to assess whether lowering BP benefited people with isolated diastolic hypertension as much as it did those without isolated diastolic hypertension. Isolated diastolic hypertension was defined as systolic BP < 130 mm Hg and diastolic BP ≥ 80 mm Hg.
They included 358,325 people, of whom 15,845 (4.4%) had isolated diastolic hypertension. Those with and without isolated diastolic hypertension had mean ages of 60.6 years and 65.2 years, respectively, and 30.0% and 42.1% were women, respectively.
People had been randomly assigned to receive either BP-lowering medicines or a placebo, usual care, or less intensive treatment.
Researchers grouped people with systolic BP < 130 mm Hg according to their diastolic pressure levels, ranging from < 60 mm Hg to ≥ 90 mm Hg.
The primary outcome was the first occurrence of a major cardiovascular event, such as fatal or nonfatal stroke, fatal or nonfatal ischemic heart disease, or heart failure causing death or hospitalization.

Over a median follow-up of 4.2 years, 43,506 major cardiovascular events were reported; 1716 occurred in patients with isolated diastolic hypertension.
A 5-mm Hg drop in systolic BP was linked to similar reductions in the risk for major cardiovascular events in people with and without isolated diastolic hypertension (P for interaction = 1.00). The estimated reduction in risk was about 10% in both groups.
In people with systolic BP < 130 mm Hg, a 5-mm Hg drop in systolic BP was linked to similar reductions in the risk for major cardiovascular events across all baseline diastolic BP levels, including < 60 mm Hg (P for interaction = .26).
The risk for major cardiovascular events did not vary by age, prior cardiovascular disease, prior BP medicine use, or BP measurement method and remained unchanged when using an alternative isolated diastolic hypertension definition (systolic BP < 140 mm Hg and diastolic BP ≥ 90 mm Hg).

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