Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study

Lopes, Antônio Alberto; Andrade, Jadelson Pinheiro de; Noblat, Antonio Carlos Beisl; Silveira, Marco Antônio

doi:10.1590/s0066-782x2001000800004

Cited by 7 publications

(2 citation statements)

References 8 publications

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“…As is widely known, the effect of high SBP is usually highlighted as a predictor of CVD events and related mortality [ 14 , 15 ]. However, only a few studies have begun to elucidate the significant effect of DBP on CVD morbidity and mortality [ 16 , 17 ]. Nevertheless, the combined effect of systolic and diastolic hypertension remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

et al. 2022

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Objectives This study aimed to examine the risk of cardiovascular disease (CVD) death according to blood pressure levels and systolic and/or diastolic hypertension. Methods From 20,636 cohort participants, 14,375 patients were enrolled after patients with prior hypertension on antihypertensive drugs were excluded. For the combination analysis, participants were divided into four groups (systolic/diastolic hypertension, systolic hypertension only, diastolic hypertension only, and non-hypertension). The risk of CV death was calculated using the hazard ratio (HR) and 95% confidence intervals (95% CI) in a Cox regression model. Results The risk of CVD death increased in systolic hypertension (HR = 1.59, 95% CI 1.26–2.00) and systolic/diastolic hypertension (HR = 1.84, 95% CI 1.51–2.25). The highest risks of hemorrhagic and ischemic stroke were observed in the diastolic hypertension (HR = 4.11, 95% CI 1.40–12.06) and systolic/diastolic hypertension groups (HR = 2.59, 95% CI 1.92–3.50), respectively. The risk of CVD death was drastically increased in those with SBP≥120 mmHg/DBP≥80 mmHg. The highest risk was observed in those with SBP of 130–131 mmHg and 134–137 mmHg. Conclusion The combined analysis of systolic and/or diastolic hypertension appears to be a good predictor of CVD death. The risk of CVD death in the prehypertensive group could be carefully monitored as well as in the hypertensive group, presumably due to less attention and the lack of antihypertensive treatment.

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Section: Discussionmentioning

confidence: 99%

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

et al. 2022

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“…Among diabetic patients enrolled in the HOT study, the incidence of cardiovascular events was significantly lower (trend test, p =0.005) in the target‐level group 80 mm Hg than in the group 90 mm Hg. The results for the nondiabetic patients were not presented in the original publication of the HOT study 53 ; however, a reanalysis of the HOT study 56 showed that the nondiabetic hypertensive patients allocated to a DBP goal 80 mm Hg had a marginally significant increase of 35.5% in cardiovascular mortality than the group allocated to a DBP goal 90 mm Hg.…”

Section: Target Blood Pressurementioning

confidence: 99%

Meeting the Challenge to Improve the Treatment of Hypertension in Blacks

Lopes

James

Port

et al. 2003

J of Clinical Hypertension

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Hypertension is more prevalent and severe in African descendent populations living outside Africa than in any other population. Given this greater burden of hypertension in blacks, it is increasingly necessary to refine strategies to prevent the disorder as well as improve its treatment and control. This review assesses results from clinical trials on lifestyle and pharmacologic interventions to identify which approaches most effectively prevent adverse hypertension-related outcomes in African descendent populations. The Dietary Approaches to Stop Hypertension (DASH) study provided evidence that a carefully controlled diet rich in fruits, vegetables, low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (i.e., the DASH diet) reduces blood pressure in blacks and is well accepted. The combination of the DASH diet with reduction in dietary sodium below 100 mmol/d may provide a reduction in blood pressure beyond that reached by the DASH diet alone. Physical exercise and interventions to reduce psychological stress may also reduce blood pressure in blacks. Strong evidence from numerous studies is a compelling argument for continuing to recommend diuretics and beta blockers as first-line antihypertensive therapy for persons of all races. Some new studies also favor angiotensin-converting enzyme inhibitors as first-line antihypertensive drugs. The African American Study of Kidney Disease and Hypertension provided evidence that an angiotensin-converting enzyme inhibitor-based treatment program is more beneficial than calcium channel blockers and beta blockers in reducing the progression of renal failure in blacks with hypertensive nephropathy. Studies in patients with diabetes have also shown evidence that both angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists are more effective than other classes of antihypertensives in reducing adverse renal events. Studies to evaluate the effects of the new antihypertensives in improving outcomes in blacks living outside the United States are needed.

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Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

America¹

2006

Journal of Cardiac Failure

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Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study

Abstract: The results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels

Cited by 7 publications

References 8 publications

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study

Meeting the Challenge to Improve the Treatment of Hypertension in Blacks

Section 3: Prevention of Ventricular Remodeling, Cardiac Dysfunction, and Heart Failure

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