Low Diastolic Blood Pressure is Not Related to Risk of First Episode of Stroke in a High-Risk Population: A Secondary Analysis of SPRINT

Piotr Sobieraj, Jacek Lewandowski, Maciej Siński, Bartosz Symonides, Zbigniew Gaciong, Piotr Sobieraj, Jacek Lewandowski, Maciej Siński, Bartosz Symonides, Zbigniew Gaciong

Abstract

Background Hypertension is the most prevalent and leading risk factor for stroke. SPRINT (The Systolic Blood Pressure Intervention Trial) assessed the effects on cardiovascular event risk of intensive compared with standard systolic blood pressure reduction. In this secondary analysis of SPRINT data, we investigated how low on-treatment diastolic blood pressure ( DBP ) influenced risk for stroke events. Methods and Results For this analysis, we used SPRINT _ POP (Primary Outcome Paper) Research Materials from the National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. Data for 8944 SPRINT participants were analyzed from the period after target blood pressure was achieved until the end of the trial. Overall, there were 110 stroke events, including 49 from the intensive-treatment arm and 61 in the standard-treatment group. In participants with DBP <70 mm Hg, stroke risk was higher than with DBP ≥70 mm Hg (hazard ratio, 1.467; 95% CI 1.009-2.133; P=0.0445). Univariable Cox proportional hazard risk analysis showed that in the whole group, age and cardiovascular and chronic renal diseases were stroke risk factors. These risk factors were related to lower DBP and higher pulse pressure, however, not to study arm. Multivariable Cox proportional hazard analysis revealed that only age, history of cardiovascular disease, current smoking status and on-treatment systolic blood pressure were significantly related to stroke risk. Conclusions Low on-treatment DBP is not related to the risk for the first stroke, in contrast to older age, the history of cardiovascular disease, current smoking status, and on-treatment systolic blood pressure. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01206062.

Trial registration: ClinicalTrials.gov NCT01206062.

Keywords: J‐shaped curve; SPRINT (Systolic Blood Pressure Intervention Trial); blood pressure; diastolic blood pressure; hypertension; stroke.

Figures

Figure 1
Figure 1
Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in standard and intensive treatment arms throughout the trial, with the current analysis period highlighted in yellow.
Figure 2
Figure 2
Kaplan–Meier plot of stroke‐free survival in participants with diastolic blood pressure (DBP) P value computed for comparison between Kaplan–Meier curves.
Figure 3
Figure 3
Plots of hazard ratios (HRs) with 95% CIs in quartiles of diastolic blood pressure (DBP) in standard and intensive treatment arms. HRs were computed in relation to the third quartile of DBP in each treatment arm. Adjustment of HR was performed as defined in a multivariate proportional hazard risk model. A and B, unadjusted and adjusted HRs in the standard treatment arm, respectively; C and D, unadjusted and adjusted HRs in the intensive treatment arm, respectively.

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