Key result
Low diastolic blood pressure (<70 mm Hg) was associated with increased risk of cardiovascular death or MI compared to 70-79 mm Hg (HR 1.50; 95% CI 1.31-1.72), independent of pulse pressure.
Why the study?
The J-shaped relationship between diastolic blood pressure and cardiovascular events in hypertensive patients with coronary artery disease may be influenced by elevated pulse pressure, but this relationship is not fully understood.
Does low diastolic blood pressure increase the risk of cardiovascular events independently of pulse pressure in hypertensive patients with stable coronary artery disease?
Observational (n=22,672)
Does low diastolic blood pressure increase the risk of cardiovascular events independently of pulse pressure in hypertensive patients with stable coronary artery disease?
The J-shaped relationship between diastolic blood pressure and cardiovascular events in hypertensive CAD patients is independent of pulse pressure, suggesting it is not solely due to advanced vascular disease.
Answers are grounded in this paper and cite their sources.
Low diastolic BP links to higher CV events independent of pulse pressure; supports perfusion hypothesis but remains hypothesis-generating in observational data.
Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40-1.87), 1.00 (ref), 1.07 (95% CI, 0.94-1.21), 1.54 (95% CI, 1.32-1.79), and 2.34 (95% CI, 1.95-2.81) for PP<45, 45 to 54 (reference), 55 to 64, 65 to 74, and ≥75 mm Hg, respectively, and 1.50 (95% CI, 1.31-1.72), 1.00 (reference), and 1.58 (95% CI, 1.42-1.77) for diastolic BPs of <70, 70 to 79 (ref), and ≥80 mm Hg, respectively. In a cross-classification analysis between diastolic BP and PP, the relationship between diastolic BP and the primary outcome remained J-shaped when the analysis was restricted to patients with the lowest-risk PP (45-64 mm Hg), with adjusted hazard ratios of 1.53 (95% CI, 1.27-1.83), 1.00 (ref), and 1.54 (95% CI, 1.34-1.75) in the <70, 70 to 79 (reference), and ≥80 mm Hg subgroups, respectively. The J-shaped relationship between diastolic BP and cardiovascular events in hypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease. CLINICAL TRIAL REGISTRATION: URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564.
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Vidal‐Petiot et al. (2017) conducted an observational in Stable coronary artery disease and hypertension (n=22,672). Low diastolic blood pressure (<70 mm Hg) vs. Diastolic blood pressure 70 to 79 mm Hg was evaluated on Cardiovascular death or myocardial infarction (HR 1.50, 95% CI 1.31-1.72). Low diastolic blood pressure (<70 mm Hg) was associated with increased risk of cardiovascular death or MI compared to 70-79 mm Hg (HR 1.50; 95% CI 1.31-1.72), independent of pulse pressure.
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