Key result
In older adults with SBP <130 mmHg, a DBP of 80-89 mmHg was not associated with increased risk of MACE compared to a DBP of 70-79 mmHg (HR 1.04; 95% CI 0.72-1.49; P=0.85).
Why the study?
The predictive value of DBP for CV risk diminishes with aging, leaving unclear whether the 2017 ACC/AHA diagnostic threshold for diastolic hypertension is associated with CV organ damage and MACEs in older adults.
Does a diastolic blood pressure of 80-89 mmHg or <70 mmHg increase the risk of major adverse cardiovascular events in older adults with systolic blood pressure < 130 mmHg?
Cohort (n=1,181)
Does a diastolic blood pressure of 80-89 mmHg or <70 mmHg increase the risk of major adverse cardiovascular events in older adults with systolic blood pressure < 130 mmHg?
Hazard Ratio: 1.04 (95% CI 0.72–1.49)
p-value: p=0.85
In older adults with controlled systolic blood pressure (<130 mmHg), a diastolic blood pressure of 80-89 mmHg is not associated with an increased risk of major adverse cardiovascular events compared to 70-79 mmHg.
May support DBP 80-89 mmHg safety in older adults with SBP <130; hypothesis-generating from observational data and needs trial confirmation.
BACKGROUND: The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline lowered the diagnostic threshold for hypertension to a systolic/diastolic blood pressure (SBP/DBP) of 130/80 mmHg. However, the predictive value of DBP for cardiovascular (CV) risk assessment diminishes with aging. The study aimed to explore whether the new diagnostic threshold for diastolic hypertension is associated with increased risk of CV organ damage and major adverse cardiovascular events (MACEs) in older adults. METHODS: 1181 individuals aged 65 years or older with SBP < 130 mmHg were enrolled a prospective cohort study. They were classified into Low (< 70 mmHg), Optimal (70 to < 80 mmHg), and High (80 to < 90 mmHg) DBP groups. Cardiac, vascular, and renal organ damage were measured at baseline. The endpoint of the study was MACEs. RESULTS: Among 1181 participants (average age 71.9 years, 44.8% men), 172 MACEs were observed during an average follow-up of 6.4 years. We found no significant differences in CV organ damage or MACEs rates (Log-rank P = 0.73) among three groups. In multivariable Cox regression, compared to the Optimal DBP group, no significant increase in CV risk was observed in the Low DBP group (hazard ratio [HR] 1.02, [95% CI 0.68-1.52], P = 0.93) or the High DBP group (HR 1.04, [95% CI 0.72-1.49], P = 0.85). Propensity score matching showed consistent results. CONCLUSION: In older adults with SBP < 130 mmHg, DBP values 80-89 mmHg were not associated with higher risk of CV organ damage, events or mortality.
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Hou et al. (2024) conducted a cohort in Older adults with systolic blood pressure < 130 mmHg (n=1,181). High diastolic blood pressure (80 to < 90 mmHg) vs. Optimal diastolic blood pressure (70 to < 80 mmHg) was evaluated on Major adverse cardiovascular events (MACEs) (HR 1.04, 95% CI 0.72-1.49, p=0.85). In older adults with SBP <130 mmHg, a DBP of 80-89 mmHg was not associated with increased risk of MACE compared to a DBP of 70-79 mmHg (HR 1.04; 95% CI 0.72-1.49; P=0.85).
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