Key result
Low DBP linked to higher all-cause mortality, with J-shaped risk for CV death.
Why the study?
There is little research or guidance on the evaluation and management of diastolic blood pressure or isolated diastolic hypertension despite hypertension's impact on cardiovascular morbidity and death.
What is the association of diastolic blood pressure and isolated diastolic hypertension with all-cause and cardiovascular mortality in adults?
Observational (n=35,109)
What is the association of diastolic blood pressure and isolated diastolic hypertension with all-cause and cardiovascular mortality in adults?
Diastolic blood pressure exhibits a U-shaped relationship with cardiovascular mortality, with both low and high DBP increasing risk, while isolated diastolic hypertension does not significantly impact mortality.
INTRODUCTION: Hypertension is common and has a significant effect on cardiovascular morbidity and death. However, despite the development of several guidelines to manage SBP, there is little research or guidance on the evaluation and management of DBP or isolated diastolic hypertension (IDH). METHOD: To determine the association of DBP with all-cause and cardiovascular mortality, we used NHANES data from 1999 to 2014 and included adults aged at least 18 years. The relationship between DBP, IDH and all-cause, cardiovascular mortality was evaluated. RESULTS: Of the 35 109 participants, all-cause death occurred in 10.6%, and cardiovascular death occurred in 2.1% over a median follow-up of 7.2 years. Multivariate Cox regression analysis revealed that the risk of all-cause mortality was significantly higher in the lowest (≤56.9 mmHg) DBP groups than in the reference group (DBP 74-76.9 mmHg). However, the risk of cardiovascular mortality was significantly higher in the lowest and highest (≥83 mmHg) DBP group than in the reference group. The risk of all-cause mortality was higher for most groups with SBP at least 140 mmHg than for the reference group with DBP 74-76.9 mmHg and SBP 100-139.9 mmHg. Both the 2018 ESC/NICE and the 2017 AHA/ACC-defined IDH was not significantly associated with all-cause mortality. CONCLUSION: DBP and all-cause mortality had an inverse relationship, whereas DBP and cardiovascular mortality had a U-shaped relationship, with the DBP reference group having the lowest risk for all-cause and cardiovascular mortality. There was no significant relationship between IDH and death.
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Bae et al. (2021) conducted an observational in Hypertension (n=35,109). Diastolic blood pressure (DBP) vs. DBP 74-76.9 mmHg was evaluated on All-cause and cardiovascular mortality. Low diastolic blood pressure (≤56.9 mmHg) was associated with higher all-cause mortality, while both low and high (≥83 mmHg) DBP were associated with higher cardiovascular mortality.
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