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Diastolic blood pressure: How less is too less?

M3 India Newsdesk May 08, 2022

As per recent research, reducing diastolic blood pressure (DBP) to further than 60 mmHg is linked to increased cardiovascular (CV) events. For patients with elevated cardiovascular risk and treated systolic blood pressure less than 130 mmHg, the research indicates that DBP between 70 and 80 mmHg is the most ideal. Read on to know why.

One of the most significant modifiable risk factors for cardiovascular disease and mortality is high blood pressure (BP). Blood pressure consists of two numbers- the systolic pressure which is the force exerted on blood vessels when the heart beats (upper number on the device) and the diastolic pressure, the force exerted when the heart is at rest (bottom number on the device). If low diastolic pressure is ignored by a busy clinician, it may put the patient in a health-risk situation.

The common perceptions of BP have shifted radically over time. The Framingham Heart Study found that systolic blood pressure (SBP) was a more significant risk factor for cardiovascular outcomes than diastolic blood pressure (DBP). This has resulted in controversy and a general disregard for the importance of DBP in estimating cardiovascular risk.

One important contentious concern is whether there is a diastolic J-shape syndrome, which implies that both high and low DBP will increase cardiovascular risk. Very low DBP has been related to an elevated risk of adverse cardiovascular outcomes referred to as the diastolic J-shape phenomenon.

The latest US recommendations prescribe a target blood pressure of less than 130/80 mmHg for intensive care but make no note of the lower DBP limit. Taking this into consideration, Jingen Li and colleagues sought to determine whether a diastolic J-shape syndrome exists in patients with treated systolic blood pressure less than 130 mmHg and to determine the safe and ideal diastolic blood pressure levels for this patient group.

The researchers accomplished this goal by conducting a cohort analysis and analysing results from patients with a high risk of cardiovascular disease. They were randomly assigned under intensive or normal blood pressure management and maintained a treated systolic blood pressure of less than 130 mmHg in the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes–Blood Pressure (ACCORD-BP) trials.

The data collection period was October 2010 to August 2015 (SPRINT) and September 1999 to June 2009 (SPRINT) (ACCORD-BP). All-cause mortality, nonfatal myocardial infarction, and non-fatal stroke were the main outcomes. The study involved 7515 patients in all (mean [age, 65.6 years; 4553 [60.6 per cent] men).

The study's main results 

The nominally lowest probability was found for the primary outcome, the composite cardiovascular outcome, non-fatal myocardial infarction, and cardiovascular mortality when diastolic blood pressure was between 70 and 80 mmHg.

A mean diastolic blood pressure of less than 60 mmHg was linked to a higher risk of the primary endpoint (HR: 1.46), composite coronary outcome (HR: 1.74), nonfatal myocardial infarction (HR: 1.73), and nonfatal stroke (HR: 1.73). (HR, 2.67). The authors concluded, "The observation that a diastolic blood pressure value of 70 to 80 mmHg was an optimal goal for this patient population merits further analysis."

Click here to see references


This article was originally published on 27 August 2021.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.

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