Low treated diastolic blood pressure levels below 85 mm Hg were associated with an increased risk of cardiac events, demonstrating a consistent J-shaped relationship.
Systematic Review
Does blood pressure reduction below a certain threshold increase the risk of cardiovascular outcomes in treated hypertensive subjects?
This review highlights a J-curve phenomenon in hypertension management, suggesting that lowering diastolic blood pressure below 85 mm Hg may paradoxically increase the risk of cardiac events.
We critically appraised the medical literature to evaluate whether there is a point beyond which blood pressure reduction in hypertensive subjects is no longer beneficial and possibly even deleterious. Thirteen studies that stratified cardiovascular outcomes by level of achieved blood pressure in treated hypertensive subjects who had been followed up for at least 1 year were critiqued by four independent reviewers. Data addressing population, protocol, and methodological characteristics were evaluated. Studies did not show a consistent J-shaped relationship between treated blood pressure and stroke, but they did demonstrate a consistent J-shaped relationship for cardiac events and diastolic blood pressure. The beneficial therapeutic threshold point was 85 mm Hg. We conclude that low treated diastolic blood pressure levels, ie, below 85 mm Hg, are associated with increased risk of cardiac events.
Lisa Farnett (Wed,) conducted a systematic review in Hypertension. Low treated diastolic blood pressure (<85 mm Hg) was evaluated on Cardiac events and stroke. Low treated diastolic blood pressure levels below 85 mm Hg were associated with an increased risk of cardiac events, demonstrating a consistent J-shaped relationship.