Does Baseline DBP Affect Outcomes of Intensive Blood Pressure Lowering?

In treating hypertension, a common concern is that lowering diastolic blood pressure (DBP) too much will lead to adverse cardiovascular outcomes. This concern is particularly relevant to intensive blood pressure lowering because intensive systolic blood pressure (SBP) reduction often leads to diastolic BP reduction.

To study this issue, researchers examined whether low baseline DBP modified the cardiovascular health benefits of intensive SBP lowering (target SBP, 110 to <130 mm Hg) observed in the randomized STEP trial involving ≈8500 older, hypertensive patients in China (NEJM JW Gen Med Aug 31 2021 and N Engl J Med 2021; 385:1268). They analyzed the incidence of the primary composite outcome (stroke, acute coronary syndrome, acute decompen…