Table 1.
Selected Observational Data Demonstrating a Diastolic BP J-Curve
| Investigators | Trial Data Analysed | Type of Observational Analysis | Number of Participants | Nadir of DBP J-Curve Reported | Inclusion and Exclusion Criteria |
|---|---|---|---|---|---|
| Cruickshank et al 198717 | HTN clinic at Clatterbridge Hospital | Prospective, cohort | 932 | 90mmHg | Included “all-comers” design, hypertensive patients. No exclusion criteria |
| Farnett et al 199118 | 13 Studies | Meta-analysis | >48,000 | 85mmHg | 13 Studies selected from 478 indexed through MEDLINE between 1966 and 1989. Studies included had at least 1 year of htn treatment, had MACE as the endpoint, stratified to at least 3 levels of BP and were either retrospective cohort or RCT |
| Messerli et al 200619 | INVEST | Retrospective analysis of RCT | 22,576 | 84mmHg | Included hypertensive patients with CAD over 50yo. Excluded MI within 3 months and class IV or V congestive heart failure |
| Bangalore et al 201021 | TNT | Retrospective analysis of RCT | 10,001 | 81.4mmHg | Included 35–75yo patients with CAD. Excluded statin allergy, pregnant women, liver disease, nephrotic syndrome, unstable angina, MI within 1 month, malabsorption, malignancy, alcohol abuse and uncontrolled hypertension, diabetes or hypothyroidism |
| Mancia et al 201136 | ONTARGET | Retrospective analysis of RCT | 31,546 | 72mmHg | Included patients with known atherosclerotic disease or diabetes. Excluded those with heart failure or uncontrolled hypertension (>160/100) |
| Tsujimoto et al 201824 | TOPCAT | Retrospective analysis of RCT | 3417 | 70mmHg | Included patients with known hypertension over 50yo. Excluded those with Ejection Fraction <45% or uncontrolled systolic hypertension (>140 or >160 mm Hg if on 3 different meds) |
| Böhm et al 201716 | ONTARGET/TRANSCEND | Meta-analysis | 29,179 | 75mmHg | Included patients over 55yo with CAD, PVD, CVA or Diabetes. Excluded CCF, ACE intolerance, Syncope, Planned CABG, Recent PCI, Uncontrolled HTN, heart transplant, liver disease, other major illness expected to reduce life expectancy or participation in the trial |
| Flint et al 201925 | KNPC | Retrospective, cohort | 1,300,000 | 80–90mmHg | All patients over 18yo in 2009 and enrolled in KPNC for the 8 year observation period were included. Excluded those without a baseline BP reading and at least 2 further BP readings during the observation period |
| McEvoy et al 201622 | ARIC | Retrospective analysis of RCT | 11,565 | 80mmHg | Included patients >50yo, with SBP ≥130 mmHg and CVD 10-year Risk ≥15%, or LVH by ECG, or ABPi <0.9, or eGFR between 20 and 59 mL/min/1.73 m2. Excluded patients with known CVD or HF |
| Böhm et al 202026 | EPHESUS | Retrospective analysis of RCT | 5929 | 70mmHg | Included patients with recent MI and associated HF or diabetes. Excluded unstable patients, uncontrolled hypotension, alcohol abuse, ICD implantation, using potassium sparing diuretics |
| Li et al 202131 | SPRINT/ACCORD | Retrospective analysis of RCT | 7515 | 60mmHg | SPRINT included patients with known hypertension over 50yo and increased CV risk. Excluded those diabetes or CVA |