Lowering blood pressure (BP) was associated with similar reductions in risk for major adverse cardiovascular events (MACE) in patients with and without isolated diastolic hypertension (IDH), with benefits consistent across diastolic BP levels, according to a meta-analysis published Dec. 12 in EHJ.

Zeinab Bidel, BSc, MSc, et al., pooled data from 51 randomized controlled trials, to assess the effects of pharmacological BP-lowering treatments in patients with and without IDH, defined as systolic BP <130 mm Hg and diastolic BP ≥80 mm Hg.

Among 358,325 participants, 15,845 (4.4%) had IDH at baseline. Individuals with IDH were younger (mean age 61 with vs. 65 years without IDH) and less likely to be women (30% with vs. 42% without IDH).

Results showed that during a median 4.2-year follow-up, 43,506 major cardiovascular events were reported; 1,716 occurred in those with IDH. A 5 mm Hg drop in systolic BP in the intervention group was associated with a 9-10% reduction in risk of MACE compared with the control group. In patients with IDH, the hazard ratio (HR) was 0.91 (95% CI, 0.82-1.01), and in those without IDH, the HR was 0.90 (95% CI, 0.89-0.92; p for interaction 1.00).

Moreover, analyses using baseline diastolic BP found that treatment effects were similar among those with baseline systolic BP <130 mm Hg (p for interaction 0.26). Notably, the MACE risk did not vary statistically by age, prior cardiovascular disease or medication use, or BP measurement methods.

In an accompanying editorial comment, Paolo Verdecchi, MD, FACC, et al., write that the current study provides "robust support for initiating or intensifying antihypertensive therapy in patients with IDH. However, ... this support ultimately stems from the lack of statistically significant differences in outcome benefit between patients with systolic-diastolic hypertension and those with IDH." He also writes that randomized trials comparing more vs. less tight BP targets are needed in patients with IDH to conclusively prove the benefits of treatment on outcomes.