Kim Dae-Hee, Cho In-Jeong, Kim Woohyeun, Lee Chan Joo, Kim Hyeon-Chang, Shin Jeong-Hun, Kang Si-Hyuck, Jung Mi-Hyang, Kwon Chang Hee, Lee Ju-Hee, Kim Hack Lyoung, Kim Hyue Mee, Cho Iksung, Kang Dae Ryong, Lee Hae-Young, Chung Wook-Jin, Kim Kwang Il, Cho Eun Joo, Sohn Il-Suk, Park Sungha, Shin Jinho, Ryu Sung Kee, Kang Seok-Min, Pyun Wook Bum, Cho Myeong-Chan, Kim Ju Han, Lee Jun Hyeok, Ihm Sang-Hyun, Sung Ki-Chul
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea.
Korean Circ J. 2022 Jun;52(6):460-474. doi: 10.4070/kcj.2021.0330. Epub 2022 Feb 15.
This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP).
A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg).
During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05-1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18-1.70) and stroke (aHR, 1.19; 95% CI, 1.08-1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04-1.16). Similar results were seen in the propensity-score-matched cohort.
Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
本研究旨在探讨在达到收缩压目标（SBP）的情况下，心血管事件与两种不同水平的治疗期间舒张压（DBP）升高之间的关联。
一项基于全国人群的队列研究纳入了237,592例接受治疗的高血压患者。主要终点是心血管死亡、心肌梗死和中风的复合终点。升高的DBP根据美国国家联合委员会第七次报告（JNC7；SBP<140 mmHg，DBP≥90 mmHg）或2017年美国心脏病学会/美国心脏协会（ACC/AHA）的定义（SBP<130 mmHg，DBP≥80 mmHg）来定义。
在中位随访9年期间，与SBP和DBP均达标的患者相比，按照JNC7定义治疗期间DBP升高与主要终点事件发生风险增加相关（调整后风险比[aHR]，1.14；95%置信区间[CI]，1.05 - 1.24），但按照2017年ACC/AHA定义则不然。按照JNC7定义治疗期间DBP升高与心血管死亡率较高（aHR，1.42；95% CI，1.18 - 1.70）及中风风险较高（aHR，1.19；95% CI，1.08 - 1.30）相关。按照2017年ACC/AHA定义治疗期间DBP升高仅与中风相关（aHR，1.10；95% CI，1.04 - 1.16）。倾向评分匹配队列中也观察到类似结果。
按照JNC7定义治疗期间DBP升高与主要心血管事件的高风险相关，而按照2017年ACC/AHA定义DBP升高仅与中风风险较高相关。该研究结果可为已达到SBP目标的受试者的DBP目标提供依据。
