HHS Public Access Author manuscript Author Manuscript
J Am Coll Cardiol. Author manuscript; available in PMC 2017 October 18. Published in final edited form as: J Am Coll Cardiol. 2016 October 18; 68(16): 1713–1722. doi:10.1016/j.jacc.2016.07.754.
Diastolic blood pressure, subclinical myocardial damage, and cardiac events: Implications for blood pressure control John W. McEvoy, M.B., B.Ch., B.A.O., M.H.S.1,2, Yuan Chen, M.S.1, Andreea Rawlings, Ph.D. 1, Ron C. Hoogeveen, Ph.D.3, Christie M. Ballantyne, M.D.3, Roger S. Blumenthal, M.D.2, Josef Coresh, M.D., Ph.D.1, and Elizabeth Selvin, M.P.H., Ph.D.1 1Department
Author Manuscript
of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2Ciccarone
Center for the Prevention of Heart Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 3Department
of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston TX
Abstract Background—The optimal systolic blood pressure (SBP) treatment goal is in question, with the SBP intervention trial (SPRINT) suggesting benefit for 120mmHg. However, achieving SBP this low may reduce diastolic BP (DBP) to levels that could compromise myocardial perfusion.
Author Manuscript
Objectives—To examine the association of DBP with prevalent and progressive myocardial damage (using high-sensitivity cardiac Troponin-T, hs-cTnT). We also examined prospective associations between DBP and coronary heart disease (CHD), stroke, or death over 21 years; overall and stratified by subgroups of interest. Methods—We studied 11,565 adults from the Atherosclerosis Risk in Communities (ARIC) study. We evaluated cross-sectional DBP and hs-cTnT (dichotomized at 14 ng/L) associations with logistic regression, longitudinal associations between DBP and hs-cTnT change using generalized linear models adjusted for attrition, and prospective associations between DBP and events with Cox regression.
Author Manuscript
Results—Mean baseline age was 57 years, 57% were female and 25% were black. Relative to persons with DBP 80–89mmHg, those with DBP 60–69mmHg and
J Am Coll Cardiol. Author manuscript; available in PMC 2017 October 18. Published in final edited form as: J Am Coll Cardiol. 2016 October 18; 68(16): 1713–1722. doi:10.1016/j.jacc.2016.07.754.
Diastolic blood pressure, subclinical myocardial damage, and cardiac events: Implications for blood pressure control John W. McEvoy, M.B., B.Ch., B.A.O., M.H.S.1,2, Yuan Chen, M.S.1, Andreea Rawlings, Ph.D. 1, Ron C. Hoogeveen, Ph.D.3, Christie M. Ballantyne, M.D.3, Roger S. Blumenthal, M.D.2, Josef Coresh, M.D., Ph.D.1, and Elizabeth Selvin, M.P.H., Ph.D.1 1Department
Author Manuscript
of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2Ciccarone
Center for the Prevention of Heart Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 3Department
of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston TX
Abstract Background—The optimal systolic blood pressure (SBP) treatment goal is in question, with the SBP intervention trial (SPRINT) suggesting benefit for 120mmHg. However, achieving SBP this low may reduce diastolic BP (DBP) to levels that could compromise myocardial perfusion.
Author Manuscript
Objectives—To examine the association of DBP with prevalent and progressive myocardial damage (using high-sensitivity cardiac Troponin-T, hs-cTnT). We also examined prospective associations between DBP and coronary heart disease (CHD), stroke, or death over 21 years; overall and stratified by subgroups of interest. Methods—We studied 11,565 adults from the Atherosclerosis Risk in Communities (ARIC) study. We evaluated cross-sectional DBP and hs-cTnT (dichotomized at 14 ng/L) associations with logistic regression, longitudinal associations between DBP and hs-cTnT change using generalized linear models adjusted for attrition, and prospective associations between DBP and events with Cox regression.
Author Manuscript
Results—Mean baseline age was 57 years, 57% were female and 25% were black. Relative to persons with DBP 80–89mmHg, those with DBP 60–69mmHg and
