Table 3.

Studies indicating low blood pressure level enhances effect of BPv

Author, year	Cohort	Cohort characteristics	Major conclusions
Poortvliet et al., 2012 [8]	PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) Trial	Men and women aged 70–82 with preexisting vascular disease in a placebo-controlled trial of pravastatin (n = 5804)*	In long-term follow-up, diastolic BPv was more predictiveof coronary events inparticipants with SBP below median (P for interaction = 0.028)
Mehlum et al., 2018 [9•]	Valsartan Antihypertensive Long-Term Use (VALUE) Trial	Randomized, double-masked trial to examine valsartan vs amlodipine in patients with hypertension and at least one additional CVD risk factor (n = 13,803)**	Association between BPv and cardiovascular events was significant both among patients with high and low BP level (P<0.0001) but was stronger among patients with BP below median of 137.8 mmHg (P for interaction <0.0001)
Nuyujukian et al., 2020 [43]	Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial	Randomized 2×2 trial to test intensive vs. standard glycemic control; also includes a BP treatment arm and lipid arm, in T2D patients with previous CVD or at high risk for CVD (n = 9383)†	Hazard ratio for heart failure with BPv increases as baseline SBP or DBP decreases, e.g., for CV-SBP, those with baseline SBP >140, <140, <130, and <120 mmHg had HRs, respectively, of 1.03, P = 0.67; 1.21, P = 0.002; 1.50, P < 0.001; 1.69, P < 0.001

^*Outcome in PROSPER: incidence of cardiovascular events, including definite or suspected death from CHD or non-fatal MI, fatal or non-fatal stroke, heart failure hospitalization, vascular mortality, and total mortality

^**Outcome in VALUE: composite cardiovascular endpoint of cardiac event or stroke. Cardiac events were sudden cardiac death, fatal MI, death during percutaneous coronary intervention or coronary bypass surgery, death due to heart failure, death associated with recent MI on autopsy, heart failure requiring hospital management, non-fatal MI, or emergency procedures to prevent MI

^†Outcome in ACCORD: congestive heart failure death or hospitalization due to HF, documented with clinical and radiologic evidence and adjudicated by endpoint committee