The log-linear relationship between blood pressure and cardiovascular events extended down to ≥90/40 mmHg, suggesting the diastolic cut-off of ≥80 mmHg may be disproportionately low.
Observational
Yes
What is the optimal cut-off for diastolic blood pressure in predicting cardiovascular events?
The study suggests that the current diastolic blood pressure cut-off of ≥80 mmHg for defining hypertension may be disproportionately low compared to the systolic cut-off of ≥130 mmHg.
AIMS: It is unclear whether a J-curve association exists in cardiovascular risk prediction and how independently systolic and diastolic blood pressure (BP) predict cardiovascular outcomes. This study evaluated the association of systolic and diastolic BP with major cardiovascular events to clarify these issues. METHODS AND RESULTS: Antihypertensive medication-naïve subjects with available BP measurements and no history of cardiovascular events were extracted from the National Health Insurance Services Health Screening Cohort. The study endpoint was a composite of cardiac death, myocardial infarction, stroke, and heart failure. The study population comprised 290 600 subjects (median follow-up duration 6.7 years). The risk for major cardiovascular events was lowest at systolic and diastolic BPs of 90-99 mmHg and 40-49 mmHg, respectively, above which BPs demonstrated a log-linear risk prediction. Systolic and diastolic BPs were highly correlated. The risk prediction of diastolic BP was inconsistent when stratified by systolic BP. A wider pulse pressure rather than a higher diastolic BP was significantly associated with cardiovascular outcomes among men aged ≥55 years. In addition, the difference between diastolic BPs of <80 mmHg and 80-89 mmHg mostly disappeared after statistical adjustment or stratification. CONCLUSION: Elevated BP is a strong predictor of future cardiovascular events including cardiac death, myocardial infarction, stroke, and heart failure. This study showed that the log-linear relationship between BP and cardiovascular events extended down to a BP of ≥90/40 mmHg. Although hypertension is defined using a lower systolic BP cut-off of ≥130 mmHg, the diastolic BP component of ≥80 mmHg seems disproportionately low.
Choi et al. (Sat,) conducted a observational in Hypertension. Blood pressure was evaluated on Cardiovascular events including cardiac death, myocardial infarction, stroke, and heart failure. The log-linear relationship between blood pressure and cardiovascular events extended down to ≥90/40 mmHg, suggesting the diastolic cut-off of ≥80 mmHg may be disproportionately low.