Time‐weighted blood pressure with cardiovascular risk among patients with or without diabetes

Background:

Usual measures of blood pressure (BP) do not account for both the magnitude and duration of exposure to elevated BP over time. We aimed to demonstrate the effect of a novel time‐weighted BP on cardiovascular outcomes using a post hoc analysis of two published randomized trials.

Hypothesis:

Time‐weighted blood pressure is associated with cardiovascular risk among patients with or without diabetes.

Methods:

The limited‐access ACCORD and SPRINT data sets were used for the current study. Time‐weighted BP is obtained by dividing cumulative BP by the total follow‐up time. Time‐weighted BP burden above a threshold is also determined after deriving the time‐weighted BP by re‐zeroing the interpolated pressure values at two different hypertension thresholds (>140/90 and >130/80 mmHg).

Results:

Eighteen thousand five hundred forty‐one patients from the two clinical trials were enrolled in this study. A J‐curve relation was observed between time‐weighted BP and major cardiovascular events (MACE). The systolic blood pressure (SBP) burden independently predicted MACE across the two trials at different thresholds (ACCORD: SBP > 130 mmHg, HR = 1.05 [1.03−1.06]; SBP > 140 mmHg, HR = 1.06 [1.04−1.08]; SPRINT: SBP > 130 mmHg, HR = 1.04 [1.03−1.05]; SBP > 140 mmHg, HR = 1.05 [1.04−1.07]). Consistent results were found for diastolic blood pressure (DBP) burden (ACCORD: DBP > 80 mmHg, HR = 1.10 [1.06−1.15]; DBP > 90 mmHg, HR = 1.20 [1.11−1.30]. SPRINT: DBP > 80 mmHg, HR = 1.06 [1.02−1.09]; DBP > 90 mmHg, HR = 1.12 [1.06−1.18]). Significant associations were also observed for stroke, myocardial infarction, cardiovascular death, and all‐cause mortality.

Conclusion:

Both time‐weighted SBP and DBP independently influenced the risk of adverse cardiovascular events among patients with and without diabetes, regardless of the definition of hypertension (130/80 or <140/90 mmHg).