Key result
A 10 mmHg DBP increase is linked to ~8% lower cardiovascular risk in older CVD patients.
Why the study?
Does the association between diastolic blood pressure and cardiovascular events in older people vary based on previous cardiovascular history?
Cohort (n=5,804)
Yes
Does the association between diastolic blood pressure and cardiovascular events in older people vary based on previous cardiovascular history?
In older adults with preexisting cardiovascular disease, higher diastolic blood pressure is paradoxically associated with a decreased risk of future cardiovascular events, highlighting the importance of considering cardiovascular history in blood pressure management.
Answers are grounded in this paper and cite their sources.
Challenges aggressive DBP lowering in older patients with prior CVD; extends observational data but leaves optimal targets unresolved.
BACKGROUND: In older age, a low DBP has been associated with increased risk of cardiovascular events, especially in frail older people. We tested the hypothesis that low DBP is associated with a high risk of cardiovascular events in people with a previous history of cardiovascular disease, as a proxy of vascular impairment. METHODS: We included 5804 participants (mean age 75 years) from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) who as part of the trial were intensively monitored for an average period of 3.2 years. DBP was categorized in low (<70 mmHg), normal (70-90 mmHg) or high (>90 mmHg). Cox proportional hazards analyses were used to estimate hazard ratio with 95% confidence intervals (CI); analyses were stratified for cardiovascular history. RESULTS: Participants with low DBP had a 1.24-fold (1.04; 1.49) increased risk of cardiovascular events compared with those with normal DBP. After further adjusting for cardiovascular factors, this association attenuated to 1.05 (0.86; 1.28). A previous history of cardiovascular disease significantly modified the relation between DBP and risk of cardiovascular events (P-interaction 0.042). In participants without a history of cardiovascular disease, DBP was marginally significantly associated with an increased event risk (hazard ratio (95% CI) per 10 mmHg increase in DBP 1.08 (0.99; 1.18), P value = 0.07), whereas in participants with a history of cardiovascular disease, higher DBP was associated with a decreased risk of cardiovascular events (hazard ratio (95% CI) per 10 mmHg increase in DBP 0.92 (0.85; 0.99, P value = 0.018). These risk estimates were independent of potential confounders, including classical cardiovascular risk factors. CONCLUSION: The association of DBP with cardiovascular events in older people varies upon their previous history, showing that in participants with preexisting cardiovascular diseases, a higher DBP associates with a decreased risk of future cardiovascular events.
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Wijsman et al. (2017) conducted a cohort in Cardiovascular disease or risk factors (n=5,804). 10 mmHg increase in diastolic blood pressure vs. Lower diastolic blood pressure was evaluated on Cardiovascular events (HR 0.92, 95% CI 0.85-0.99, p=0.018). In older participants with a history of cardiovascular disease, a 10 mmHg increase in diastolic blood pressure was associated with an 8% decreased risk of cardiovascular events (HR 0.92).
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