Korean Circulation Journal

  • 제52권6호
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  • Pages.460-474
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  • 2022
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets

  • Dae-Hee Kim (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • In-Jeong Cho (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University) ;
  • Woohyeun Kim (Cardiovascular Center, Korea University Guro Hospital) ;
  • Chan Joo Lee (Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Hyeon-Chang Kim (Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Jeong-Hun Shin (Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Si-Hyuck Kang (Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Mi-Hyang Jung (Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Chang Hee Kwon (Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Ju-Hee Lee (Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Hack Lyoung Kim (Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Hyue Mee Kim (Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Iksung Cho (Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Dae Ryong Kang (Department of Precision Medicine, Wonju College of Medicine, Yonsei University) ;
  • Hae-Young Lee (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Wook-Jin Chung (Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University) ;
  • Kwang Il Kim (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Eun Joo Cho (Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea) ;
  • Il-Suk Sohn (Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong) ;
  • Sungha Park (Cardiovascular Center, Korea University Guro Hospital) ;
  • Jinho Shin (Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Sung Kee Ryu (Division of Cardiology, Department of Internal Medicine, Eulji Medical School of Medicine) ;
  • Seok-Min Kang (Cardiovascular Center, Korea University Guro Hospital) ;
  • Wook Bum Pyun (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University) ;
  • Myeong-Chan Cho (Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Ju Han Kim (Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital) ;
  • Jun Hyeok Lee (Department of Biostatistics, Wonju College of Medicine, Yonsei University) ;
  • Sang-Hyun Ihm (Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Ki-Chul Sung (Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2021.09.28
  • 심사 : 2022.01.24
  • 발행 : 2022.06.01
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초록

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05-1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18-1.70) and stroke (aHR, 1.19; 95% CI, 1.08-1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04-1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion: Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

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과제정보

National Health Information Database was provided by the National Health Insurance Service (NHIS) of the Republic of Korea. The authors thank the National Health Insurance Service for cooperation.

참고문헌

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:2199-269. https://doi.org/10.1016/j.jacc.2017.11.005
  2. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-104. https://doi.org/10.1093/eurheartj/ehy339
  3. Lewington S, Clarke R, Qizilbash N, Peto R, Collins RProspective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13. https://doi.org/10.1016/S0140-6736(02)11911-8
  4. Yano Y, Reis JP, Tedla YG, et al. Racial differences in associations of blood pressure components in young adulthood with incident cardiovascular disease by middle age: Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA Cardiol 2017;2:381-9. https://doi.org/10.1001/jamacardio.2016.5678
  5. Flint AC, Conell C, Ren X, et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med 2019;381:243-51. https://doi.org/10.1056/NEJMoa1803180
  6. Zhang Y, Vittinghoff E, Pletcher MJ, et al. Associations of blood pressure and cholesterol levels during young adulthood with later cardiovascular events. J Am Coll Cardiol 2019;74:330-41. https://doi.org/10.1016/j.jacc.2019.03.529
  7. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens 2016;34:613-22. https://doi.org/10.1097/HJH.0000000000000881
  8. Bohm M, Schumacher H, Teo KK, et al. Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120-140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Eur Heart J 2018;39:3105-14. https://doi.org/10.1093/eurheartj/ehy287
  9. Franklin SS. The importance of diastolic blood pressure in predicting cardiovascular risk. J Am Soc Hypertens 2007;1:82-93. https://doi.org/10.1016/j.jash.2006.11.004
  10. Petrovitch H, Curb JD, Bloom-Marcus E. Isolated systolic hypertension and risk of stroke in Japanese-American men. Stroke 1995;26:25-9. https://doi.org/10.1161/01.STR.26.1.25
  11. Strandberg TE, Salomaa VV, Vanhanen HT, Pitkala K, Miettinen TA. Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years. J Hypertens 2002;20:399-404. https://doi.org/10.1097/00004872-200203000-00014
  12. Hozawa A, Ohkubo T, Nagai K, et al. Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home: the Ohasama study. Arch Intern Med 2000;160:3301-6. https://doi.org/10.1001/archinte.160.21.3301
  13. Lee H, Yano Y, Cho SM, et al. Cardiovascular risk of isolated systolic or diastolic hypertension in young adults. Circulation 2020;141:1778-86. https://doi.org/10.1161/CIRCULATIONAHA.119.044838
  14. Lee H, Yano Y, Cho SM, Park S, Lloyd-Jones DM, Kim HC. Cardiovascular risk of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association blood pressure guideline: a nationwide age-stratified cohort study. Hypertension 2020;76:e44-6. https://doi.org/10.1161/HYPERTENSIONAHA.120.16018
  15. McEvoy JW, Daya N, Rahman F, et al. Association of isolated diastolic hypertension as defined by the 2017 ACC/AHA blood pressure guideline with incident cardiovascular outcomes. JAMA 2020;323:329-38. https://doi.org/10.1001/jama.2019.21402
  16. Cheol Seong S, Kim YY, Khang YH, et al. Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol 2017.46:799-800. https://doi.org/10.1093/ije/dyw253
  17. Seong SC, Kim YY, Park SK, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open 2017;7:e016640.
  18. Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173:676-82. https://doi.org/10.1093/aje/kwq433
  19. Park TH, Choi JC. Validation of stroke and thrombolytic therapy in Korean National Health Insurance claim data. J Clin Neurol 2016;12:42-8. https://doi.org/10.3988/jcn.2016.12.1.42
  20. Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL. Everolimus-eluting stents or bypass surgery for multivessel coronary disease. N Engl J Med 2015;372:1213-22. https://doi.org/10.1056/NEJMoa1412168
  21. Mancia G. Blood pressure reduction and cardiovascular outcomes: past, present, and future. Am J Cardiol 2007;100:3J-9J. https://doi.org/10.1016/j.amjcard.2007.05.008
  22. Muntner P, Whelton PK. Using predicted cardiovascular disease risk in conjunction with blood pressure to guide antihypertensive medication treatment. J Am Coll Cardiol 2017;69:2446-56. https://doi.org/10.1016/j.jacc.2017.02.066
  23. Yano Y, Stamler J, Garside DB, et al. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. J Am Coll Cardiol 2015;65:327-35. https://doi.org/10.1016/j.jacc.2014.10.060
  24. Choi YJ, Kim SH, Kang SH, et al. Reconsidering the cut-off diastolic blood pressure for predicting cardiovascular events: a nationwide population-based study from Korea. Eur Heart J 2019;40:724-31. https://doi.org/10.1093/eurheartj/ehy801
  25. Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease. The Framingham study. Am J Cardiol 1971;27:335-46. https://doi.org/10.1016/0002-9149(71)90428-0
  26. Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001;103:1245-9. https://doi.org/10.1161/01.CIR.103.9.1245
  27. Fang J, Madhavan S, Cohen H, Alderman MH. Isolated diastolic hypertension. A favorable finding among young and middle-aged hypertensive subjects. Hypertension 1995;26:377-82. https://doi.org/10.1161/01.HYP.26.3.377
  28. Blank SG, Mann SJ, James GD, West JE, Pickering TG. Isolated elevation of diastolic blood pressure. Real or artifactual? Hypertension 1995;26:383-9. https://doi.org/10.1161/01.HYP.26.3.383
  29. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998;351:1755-62. https://doi.org/10.1016/S0140-6736(98)04311-6