Medical Service, Veterans Affairs Salt Lake City Health Care System, UT (S.B., A.K.C.)Division of Nephrology and Hypertension (S.B., A.K.C., G.W.)Division of Biostatistics (T.G.)Division of General Internal Medicine (M.C.)University of Utah School of Medicine, Salt Lake City. Stanford University, Palo Alto, CA (G.M.C.)Veterans Affairs Medical Center, Memphis, TN (W.C.C.)Case Western Reserve University, Cleveland, OH (M.R., E.H.)Medical University of South Carolina, Charleston (R.C.C., R.P.)Section on Nephrology (B.I.F.)Section on Cardiology (D.K.)Wake Forest School of Medicine, Winston-Salem, NC. Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL (W.H.)Metrohealth Medical Center, Cleveland, OH (E.H.)University of Illinois at Chicago, IL (J.L.)Division of Cardiology, Veterans Administration Medical Center, Washington, DC (V.P.)Ralph H. Johnson VA Medical Center, Charleston, SC (R.P.)Intermountain Medical Center, Murray, UT (E.R.)Icahn School of Medicine at Mount Sinai, New York, NY (C.R.)Oregon State Health University Portland (S.G.W.)Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.)Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.).
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Background:In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear.Methods:SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target <120 mm Hg) and standard (target <140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP.Results:Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level (P for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57–1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61–0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction P value of 0.78. Results were similar for all-cause death and kidney events.Conclusions:Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP.Clinical Trial Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.