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TY - JOUR

T1 - J Curve in Patients Randomly Assigned to Different Systolic Blood Pressure Targets An Experimental Approach to an Observational Paradigm

AU - Kalkman, Deborah N.

AU - Brouwer, Tom F.

AU - Vehmeijer, Jim T.

AU - Berger, Wouter R.

AU - Knops, Reinoud E.

AU - de Winter, Robbert J.

AU - Peters, Ron J.

AU - van den Born, Bert-Jan H.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Low systolic blood pressure (SBP) values are associated with an increased risk of cardiovascular events, giving rise to the so-called J-curve phenomenon. We assessed the association between on-treatment SBP levels, cardiovascular events, and all-cause mortality in patients randomized to different SBP targets. METHODS: Data from 2 large randomized trials that randomly allocated hypertensive patients at high risk for cardiovascular disease to intensive (SBP <120 mm Hg) or conventional (SBP <140 mm Hg) treatment were pooled and harmonized for outcomes and follow-up duration. Using natural cubic splines, we plotted the hazard ratio for all-cause mortality and cardiovascular events against the mean on-treatment SBP per treatment group. RESULTS: The pooled data consisted of 194875 on-treatment SBP measurements in 13946 patients (98.9%). During a median follow-up of 3.3 years, cardiovascular events occurred in 1014 patients (7.3%), and 502 patients died (3.7%). For both blood pressure targets, an identical shape of the J curve was present, with a nadir for cardiovascular events and all-cause mortality just below the SBP target. Patients in the lowest SBP stratum were older, had a higher body mass index, smoked more often, and had a higher frequency of diabetes mellitus and cardiovascular events. CONCLUSIONS: Low on-treatment SBP levels are associated with increased cardiovascular events and all-cause mortality. This association is independent of the attained blood pressure level because the J curve aligns with the SBP target. Our results suggest that the benefit or risk associated with intensive blood pressure-lowering treatment can be established only via randomized clinical trials

AB - BACKGROUND: Low systolic blood pressure (SBP) values are associated with an increased risk of cardiovascular events, giving rise to the so-called J-curve phenomenon. We assessed the association between on-treatment SBP levels, cardiovascular events, and all-cause mortality in patients randomized to different SBP targets. METHODS: Data from 2 large randomized trials that randomly allocated hypertensive patients at high risk for cardiovascular disease to intensive (SBP <120 mm Hg) or conventional (SBP <140 mm Hg) treatment were pooled and harmonized for outcomes and follow-up duration. Using natural cubic splines, we plotted the hazard ratio for all-cause mortality and cardiovascular events against the mean on-treatment SBP per treatment group. RESULTS: The pooled data consisted of 194875 on-treatment SBP measurements in 13946 patients (98.9%). During a median follow-up of 3.3 years, cardiovascular events occurred in 1014 patients (7.3%), and 502 patients died (3.7%). For both blood pressure targets, an identical shape of the J curve was present, with a nadir for cardiovascular events and all-cause mortality just below the SBP target. Patients in the lowest SBP stratum were older, had a higher body mass index, smoked more often, and had a higher frequency of diabetes mellitus and cardiovascular events. CONCLUSIONS: Low on-treatment SBP levels are associated with increased cardiovascular events and all-cause mortality. This association is independent of the attained blood pressure level because the J curve aligns with the SBP target. Our results suggest that the benefit or risk associated with intensive blood pressure-lowering treatment can be established only via randomized clinical trials

U2 - 10.1161/CIRCULATIONAHA.117.030342

DO - 10.1161/CIRCULATIONAHA.117.030342

M3 - Article

C2 - 28939617

VL - 136

SP - 2220

EP - 2229

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 23

ER -