Intensive BP Control Is Effective and Safe Across Low and High DBP Levels

Intensive blood pressure (BP) control targeting <130/80 mm Hg reduced cardiovascular events and mortality consistently across all baseline diastolic blood pressure (DBP) strata in a post hoc analysis of 33,288 participants from the China Rural Hypertension Control Project, with no evidence that lower DBP diminished benefit. Participants were categorized into quartiles of baseline DBP (≤80.7, 80.7–87.3, 87.3–94.3, and >94.3 mm Hg), and compared with usual care, intensive management led to substantial risk reductions in cardiovascular outcomes in every group, with adjusted hazard ratios ranging from 0.59 to 0.69 and a non-significant interaction between treatment effect and DBP level. Although intensive treatment increased the risk of hypotension across DBP categories, it did not raise the incidence of injurious falls, syncope, or adverse kidney outcomes. Delivered by non-physician providers, this intervention demonstrates that intensive BP lowering is broadly effective and safe even among individuals with lower baseline DBP, supporting its application in real-world high BP populations. A J-curve relationship between DBP and CVD events has been proposed. However, evidence from Mendelian randomization studies refuted the J-shaped association and established a linear correlation between DBP and CVD.  Source: https://heart.bmj.com/