Blood pressure lowering in isolated diastolic hypertension and cardiovascular risk: an individual patient data meta-analysis

作者：Zeinab Bidel, Milad Nazarzadeh, Dexter Canoy, John W. McEvoy, Rusitanmujiang Maimaitiaili, John Chalmers, Koon Teo, Carl J. Pepine, Barry R. Davis, Kazem Rahimi, Amanda Adler, Larry Agodoa, Ale Algra, Folkert W. Asselbergs, Nigel Beckett, Eivind Berge, Henry R. Black, Eric Boersma, Frank P. Brouwers, Morris J. Brown, Jasper J. Brugts, Christopher J. Bulpitt, Robert P. Byington, William C. Cushman, Jeffrey A. Cutler, Richard B Devereaux, Jamie P. Dwyer, Ray Estacio, Robert Fagard, Kim Fox, Tsuguya Fukui, Ajay Gupta, Rury R. Holman, Yutaka Imai, Masao Ishii, Stevo Julius, Yoshihiko Kanno, Sverre E. Kjeldsen, John B. Kostis, Kizuku Kuramoto, Jan Lanke, Edmund J. Lewis, Julia B. Lewis, Michel Lièvre, Lars Lindholm, Stephan Lueders, Stephen MacMahon, Giuseppe Mancia, Masunori Matsuzaki, Maria H. Mehlum, Steven Nissen, Hiroshi Ogawa, Toshio Ogihara, Takayoshi Ohkubo, Christopher R. Palmer, Anushka Patel, Marc Allan Pfeffer, Bertram Pitt, Neil R Poulter, Hiromi Rakugi, Gianpaolo Reboldi, Christopher M. Reid, Giuseppe Remuzzi, Piero Ruggenenti, Takao Saruta, Joachim Schrader, Robert W. Schrier, Peter Sever, Peter Sleight, Jan A. Staessen, Hiromichi Suzuki, Lutgarde Thijs, Kenji Ueshima, Seiji Umemoto, Wiek H. van Gilst, Paolo Verdecchia, Kristian Wachtell, Paul K. Whelton, Lindon Wing, Mark Woodward, Yoshiki Yui, Salim Yusuf, Alberto Zanchetti, Zhen‐Yu Zhang, Craig S. Anderson, Colin Baigent, Barry M. Brenner, Rory Collins, Dick de Zeeuw, Jacobus Lubsen, Ettore Malacco, Bruce Neal, Vlado Perkovic, Anthony Rodgers, Peter M. Rothwell, Gholamreza Salimi-Khorshidi, Johan Sundström, Fiona Turnbull, Giancarlo Viberti, Ji‐Guang Wang · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf962 · 被引用次数：3 · 研究领域：Blood Pressure and Hypertension Studies、Hormonal Regulation and Hypertension、Renin-Angiotensin System Studies

BACKGROUND AND AIMS: Blood pressure (BP) lowering reduces cardiovascular disease (CVD) risk; however, the benefits of treating patients with normal systolic BP but elevated diastolic BP remain uncertain. METHODS: Data from 51 randomized controlled trials were pooled to compare BP-lowering effects in participants with and without isolated diastolic hypertension (IDH), defined as systolic BP < 130 mmHg and diastolic BP ≥ 80 mmHg. Treatment effects were stratified across baseline diastolic BP categories (range < 60 to ≥90 mmHg) among individuals with baseline systolic BP < 130 mmHg. Fixed-effect one-stage individual participant data meta-analyses were used, and Cox proportional hazard models, stratified by trial, were applied to analyse the data. RESULTS: Among 358 325 participants, 15 845 (4.4%) had IDH. At a median follow-up of 4.2 years, a 5 mmHg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with IDH [hazard ratio 0.91; 95% confidence interval (CI) 0.82-1.01] and those without IDH (hazard ratio 0.90; 95% CI 0.89-0.92; P for interaction = 1.00). Analyses by baseline diastolic BP showed no evidence of heterogeneity in treatment effects among individuals with baseline systolic BP < 130 mmHg (P for interaction = .26). Relative treatment effects were not statistically different by CVD history, age, prior medication use, and BP measurement methods. CONCLUSIONS: The study found no evidence to suggest that pharmacological BP-lowerin...