Photo Credit: Siarhei Khaletski

The following is a summary of “Baseline Diastolic BP and BP-Lowering Effects on Cardiovascular Outcomes and All-Cause Mortality A Meta Analysis,” published in the November 2024 issue of Nephrology by Sarwal et al. 

Researchers conducted a retrospective study to examine whether baseline diastolic BP modifies the effects of BP lowering on clinical outcomes.  

They conducted a meta-analysis using individual participant data from 5 trials: Systolic Blood Pressure Intervention (N = 9361), Action to Control Cardiovascular Risk in Diabetes (N = 2362), Secondary Prevention of Small Subcortical Strokes (N = 3020), African American Study of Kidney Disease (N = 1094), and Modification of Diet in Renal Disease (N = 840). They used DerSimonian-Laird random-effects models to assess baseline diastolic BP’s effect on cardiovascular, all-cause mortality, and kidney outcomes. 

The results showed that the mean baseline age was 65 ± 10 years, with systolic and diastolic BP of 141 ± 17 mm Hg and 79 ± 12 mm Hg, respectively. Intensive BP control reduced the risk of composite cardiovascular outcomes (HR 0.79, 95% CI 0.72, 0.87) and all-cause mortality (HR 0.86, 95% CI 0.75, 0.99), with no modification by baseline diastolic BP (interaction P = 0.76 for cardiovascular and P = 0.85 for mortality). The mean baseline diastolic BP for the lowest and upper 3 quartiles was 65 ± 6 mm Hg and 84 ± 9 mm Hg, respectively, with similar effects on outcomes in both groups. No interaction was found for kidney outcomes. 

They concluded that baseline diastolic BP did not modify the benefits of intensive BP lowering. The effects were consistent across the range. 

Source: journals.lww.com/jasn/abstract/9900/baseline_diastolic_bp_and_bp_lowering_effects_on.481.aspx