Photo Credit: Liudmila Chernetska

A study on ACCORD and SPRINT trials found a J-curve relationship between time-weighted blood pressure and cardiovascular events, emphasizing the independent risk predictive power of systolic and diastolic blood pressure burdens, regardless of standard thresholds.

The following is a summary of “Time-weighted blood pressure with cardiovascular risk among patients with or without diabetes,” published in the January 2024 issue of Cardiology by Jiang et al.

Traditional methods of measuring blood pressure (BP) lack consideration for the combined impact of prolonged periods and intensity of elevated BP levels.

Researchers conducted a retrospective study to showcase the impact of a novel time-weighted BP metric on cardiovascular outcomes through a post hoc analysis of two previously published randomized trials.

They utilized the restricted-access ACCORD and SPRINT datasets for this investigation. Time-weighted BP was calculated by dividing the cumulative BP by the total follow-up duration. Additionally, they determined the burden of time-weighted BP surpassing specific thresholds by recalculating the time-weighted BP with interpolated pressure values reset at two distinct hypertension thresholds, specifically greater than 140/90 mmHg and greater than 130/80 mmHg.

The results showed a J-curve relationship between time-weighted BP and major cardiovascular events (MACE) in 18,541 patients across two clinical trials. Systolic blood pressure (SBP) burden independently predicted MACE in both trials at different thresholds (ACCORD: SBP > 130 mmHg, HR = 1.05 [1.03−1.06]; SBP > 140 mmHg, HR = 1.06 [1.04−1.08]; SPRINT: SBP > 130 mmHg, HR = 1.04 [1.03−1.05]; SBP > 140 mmHg, HR = 1.05 [1.04−1.07]). A consistent results were found for diastolic blood pressure (DBP) burden (ACCORD: DBP > 80 mmHg, HR = 1.10 [1.06−1.15]; DBP > 90 mmHg, HR = 1.20 [1.11−1.30]. SPRINT: DBP > 80 mmHg, HR = 1.06 [1.02−1.09]; DBP > 90 mmHg, HR = 1.12 [1.06−1.18]). Significant associations were also observed for stroke, myocardial infarction, cardiovascular death, and all-cause mortality.

Investigators concluded that regardless of standard 130/80 or <140/90 mmHg thresholds, time-weighted systolic and diastolic BP independently boosted heart risks for all, with or without diabetes.

Source: onlinelibrary.wiley.com/doi/10.1002/clc.24213