Abstract 10123: Evidence Against the J-shaped Curve in Treated Hypertensive Patients With Increased Cardiovascular Risk: The VALUE Trial
Introduction: It has been postulated that low blood pressure (BP) during treatment is associated with increased risk for cardiovascular (CV) disease.
Hypothesis: We tested whether low BP had unfavorable effect on CV outcomes in a high risk population of 15,244 hypertensive patients of whom 45% had a coronary heart disease (CHD) history.
Methods: Patients were followed for 4.2 years (mean) in the VALUE Trial with no difference of the primary endpoint between valsartan and amlodipine arms. Cox proportional hazard models were used to evaluate relationships between average on-treatment BP and clinical outcomes, unadjusted and adjusted for baseline covariates such as age, BMI, history of CHD, history of stroke, left ventricular hypertrophy, diabetes mellitus, smoking, cholesterol and proteinuria.
Results: Diastolic BP ≥90 mmHg but not diastolic BP <70 mmHg was associated with increased CV outcomes after covariate adjustment. We had similar results for death, myocardial infarction (MI), heart failure and stroke. Nadir for MI was at diastolic BP of 76 mmHg and for stroke 60 mmHg. The ratio of MI to stroke increased with lower diastolic BP (fig), but there was no significant J-curve regardless of CHD history. Also, systolic BP ≥140 but not <130 mmHg was associated with increased risk for CV outcomes, and systolic BP <130 mmHg significantly prevented stroke.
Conclusions: Patients in BP strata ≥140/90 mmHg, but not patients in BP strata <130/70 mmHg, were at increased risk for adverse outcomes in this hypertensive, high risk population. Our data provide evidence against a J-curve in the treatment of hypertensive patients with high risk and support the concept “of the lower the better” in stroke prevention. However, the increase in the ratio of MI to stroke with lower diastolic BP indicates target organ heterogeneity in that the optimal on-treatment diastolic BP for cerebroprotection is below the one for cardioprotection.
Author Disclosures: S.E. Kjeldsen: Honoraria; Modest; Bayer, MSD, Novartis,Takeda. Consultant/Advisory Board; Modest; Bayer, Serodus, Takeda. S. Bangalore: None. F. Messerli: None. G. Mancia: None. B. Holzhauer: Employment; Significant; Employee of Novartis. Ownership Interest; Significant; Shareholder in Novartis. T.A. Hua: Employment; Significant; Employee of Novartis. Ownership Interest; Significant; Shareholder in Novartis. D. Zappe: Employment; Significant; Employee of Novartis. Ownership Interest; Significant; Shareholder in Novartis. M.A. Weber: None. S. Julius: None.
- © 2015 by American Heart Association, Inc.