Intensive Blood Pressure Lowering in Individuals With Low Diastolic Blood Pressure and Elevated Troponin Levels in SPRINT

Cady Smith, Jarett D. Berry, Rebecca Scherzer, James A. de Lemos, Vijay Nambi, Christie M. Ballantyne, Richard L. Kravitz, Anthony A. Killeen, Joachim H. Ix, Michael G. Shlipak, Simon B. Ascher

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Among individuals with hypertension and low diastolic blood pressure (DBP), the optimal BP target remains controversial due to concerns that BP lowering may reduce coronary perfusion. We determined the impact of intensive BP control among individuals with elevated systolic BP who have low DBP and elevated hs-cTnT (high-sensitivity cardiac troponin T) levels. METHODS AND RESULTS: A total of 8828 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were stratified by baseline DBP. Those with low DBP (<70 mm Hg) were further stratified by elevated hs-cTnT (≥14 ng/L) at baseline. The effects of intensive versus standard BP lowering on a cardiovascular disease composite end point, all-cause death, and 1-year change in hs-cTnT were determined. The combination of low DBP/high hs-cTnT was independently associated with a higher risk for cardiovascular disease and all-cause death, as well as greater 1-year increases in hs-cTnT, compared with DBP ≥70 mm Hg. However, randomization to intensive versus standard BP lowering led to similar reductions in cardiovascular disease risk among individuals with low DBP/high hs-cTnT (hazard ratio [HR], 0.82 [95% CI, 0.57–1.19]), low DBP/low hs-cTnT (HR, 0.48 [95% CI, 0.29–0.79]), and DBP ≥70 mm Hg (HR, 0.73 [95% CI, 0.60–0.89]; P for interaction=0.20). Intensive BP lowering also led to a reduction in all-cause death that was similar across groups (P for interaction=0.57). CONCLUSIONS: In this nonprespecified subgroup analysis of SPRINT, individuals with low DBP and elevated hs-cTnT, low DBP and nonelevated hs-cTnT, and DBP ≥70 mm Hg derived similar cardiovascular disease and mortality benefits from intensive BP lowering. These findings warrant confirmation in other studies.

Original languageEnglish (US)
Article numbere032493
JournalJournal of the American Heart Association
Issue number6
StatePublished - Mar 19 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


  • J curve
  • diastolic blood pressure
  • hypertension
  • troponin

PubMed: MeSH publication types

  • Journal Article


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