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.

키워드

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.

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