Key result
Isolated low diastolic blood pressure (<60 mmHg) was associated with a 1.32-fold increased risk of major adverse cardiovascular events (HR 1.32) compared to a diastolic blood pressure of 60-79 mmHg in treated hypertensive patients with normalized systolic blood pressure.
Why the study?
The prognosis of high or markedly low DBP with normalized on-treatment SBP on MACE is uncertain.
Does isolated low diastolic blood pressure or isolated diastolic hypertension increase the risk of MACE in treated hypertensive patients with normalized systolic blood pressure?
Observational (n=7,582)
Yes
Does isolated low diastolic blood pressure or isolated diastolic hypertension increase the risk of MACE in treated hypertensive patients with normalized systolic blood pressure?
In treated hypertensive patients with normalized systolic blood pressure, isolated low diastolic blood pressure (<60 mmHg) is associated with an increased risk of MACE, whereas isolated diastolic hypertension (≥80 mmHg) is not.
May warrant caution against diastolic BP <60 mmHg in treated hypertension; leaves open optimal targets for randomized trials.
Background The prognosis of high or markedly low diastolic blood pressure (DBP) with normalized on-treatment systolic blood pressure (SBP) on major adverse cardiovascular events (MACE) is uncertain. This study examined whether isolated diastolic hypertension (IDH) and isolated low DBP (ILDBP) were associated with MACE in treated patients. Methods 7582 hypertensive patients with on-treatment SBP <130 mmHg from the Systolic Blood Pressure Intervention Trial (SPRINT) were categorized based on average DBP: <60 mmHg (n=1031; ILDBP), 60–79 mmHg (n=5432), ≥80 mmHg (n=1119; IDH). MACE risk was estimated using Cox proportional hazards models. The analysis was supplemented by a meta-analysis involving 10106 SPRINT and four cohort participants. Results Median age of the SPRINT participants was 67.0 years, and 64.9% were men. Over a median follow-up of 3.4 years, 512 patients developed MACE. The incidence of MACE was 3.9 cases per 100 person-years for ILDBP, 1.9 cases for DBP 60–79 mmHg, and 1.8 cases for IDH. ILDBP was associated with 1.32-fold increased MACE risk (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05–1.66), whereas IDH was not (HR: 1.18, 95% CI: 0.87–1.59). There was no effect modification by age, sex, atherosclerotic cardiovascular disease risk, or cardiovascular disease history (all p-values for interaction >0.05). The meta-analysis indicated increased MACE risk in ILDBP (HR: 1.26, 95% CI: 1.05–1.52) compared with DBP 60–79 mmHg. Conclusions In treated patients with normalized SBP, excessively low DBP was associated with increased MACE risk, while IDH was not. Further research is required for ILDBP management.
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Chang et al. (2023) conducted an observational in Hypertension (n=7,582). Isolated low diastolic blood pressure (<60 mmHg) vs. Diastolic blood pressure 60-79 mmHg was evaluated on Major adverse cardiovascular events (MACE) (HR 1.32, 95% CI 1.05-1.66). Isolated low diastolic blood pressure (<60 mmHg) was associated with a 1.32-fold increased risk of major adverse cardiovascular events (HR 1.32) compared to a diastolic blood pressure of 60-79 mmHg in treated hypertensive patients with normalized systolic blood pressure.
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