BACKGROUND Lowering blood pressure (BP) in persons with low diastolic BP could be harmful. Hence, we examined whether baseline diastolic BP modifies the effects of BP lowering on clinical outcomes in a meta-analysis of five large BP lowering trials. METHODS In a study-level meta-analysis based on individual participant data of the Systolic Blood Pressure Intervention Trial (N = 9361), the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (N = 2362), the Secondary Prevention of Small Subcortical Strokes (N = 3020), the African American Study of Kidney Disease and Hypertension (N = 1094) and the Modification of Diet in Renal Disease (N = 840) studies, we used DerSimonian-Laird random-effects models to examine the dependence of the effect of the BP lowering intervention on baseline diastolic BP for cardiovascular, all-cause mortality and kidney outcomes. RESULTS Mean baseline age was 65 ± 10 years old. Mean baseline systolic and diastolic BP were 141 ± 17 and 79 ± 12 mm Hg, respectively. More intensive BP control resulted in lower risk of composite cardiovascular outcome (HR 0.79, 95% CI 0.72, 0.87) and all-cause mortality (HR 0.86, 95% CI 0.75, 0.99) without evidence that the BP intervention effects differed by level of baseline diastolic BP (interaction p = 0.76 for cardiovascular composite and 0.85 for all-cause mortality). The mean baseline diastolic BP in the lowest and the upper three quartiles of baseline diastolic BP were 65 ± 6 mm Hg and 84 ± 9 mm Hg, respectively but the effects of the BP interventions on the outcomes were similar in both groups. Furthermore, there was no evidence of interaction of the BP intervention and baseline diastolic BP for kidney outcomes. CONCLUSIONS Within the included diastolic BP range, there was no evidence that baseline diastolic BP modified the beneficial effects of intensive BP lowering.

中文翻译：

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基线舒张压和降压对心血管结局和全因死亡率的影响：荟萃分析。


背景 降低舒张压低的人的血压 （BP） 可能是有害的。因此，我们在对 5 项大型降压试验的荟萃分析中检查了基线舒张压是否会改变降压对临床结局的影响。方法 在基于收缩压干预试验 （N = 9361） 的个体参与者数据的研究级荟萃分析中，控制糖尿病血压心血管风险的行动 （N = 2362）、小皮质下中风的二级预防 （N = 3020）、非裔美国人肾脏疾病和高血压研究 （N = 1094） 和肾脏疾病饮食调整 （N = 840） 研究， 我们使用 DerSimonian-Laird 随机效应模型来检查降压干预对心血管、全因死亡率和肾脏结局基线舒张压影响的依赖性。结果 平均基线年龄为 65 ± 10 岁。平均基线收缩压和舒张压分别为 141 ± 17 和 79 ± 12 mm Hg。更强化的血压控制导致复合心血管结局的风险降低 （HR 0.79， 95% CI 0.72， 0.87） 和全因死亡率 （HR 0.86， 95% CI 0.75， 0.99），没有证据表明血压干预效果因基线舒张压水平而异 （心血管复合交互作用 p = 0.76，全因死亡率 0.85）。基线舒张压最低和上三个四分位数的平均基线舒张压分别为 65 ± 6 mm Hg 和 84 ± 9 mm Hg，但两组血压干预对结局的影响相似。此外，没有证据表明 BP 干预和基线舒张压对肾脏结局的相互作用。 结论 在纳入的舒张压范围内，没有证据表明基线舒张压改变了强化降压的有益效果。