Lower diastolic blood pressure (<60 mmHg) was associated with a significantly lower risk of MI, HF, stroke, and death compared to DBP ≥110 mmHg (HR 0.24; P<0.001) over 10 years.
Cohort (n=5,653,590)
Yes
Does lower diastolic blood pressure reduce the composite of MI, HF, stroke, and total death in young adults aged 20-39?
In young adults aged 20-39, lower diastolic blood pressure is linearly associated with better 10-year cardiovascular outcomes without a J-curve phenomenon, irrespective of baseline hypertension status.
Effect estimate: HR 0.24
Absolute Event Rate: 1.08% vs 10.44%
p-value: p=<0.001
Abstract Background It is uncertain whether low diastolic blood pressure (DBP) is harmful or beneficial. We investigated the relation of DBP level and clinical events in young age in 10year follow-up. Methods We enrolled adults aged 20-39 with/without hypertension from 2007-2010 using the Korean national Insurance data. They were categorized to 7 groups according to DBP level as 60mmHg, 60-69mmHg, 70-79mmHg, 80-89mmHg, 90-99mmHg, 100-109mmHg and ≥110mmHg. We investigated 10-year clinical outcomes among 7 groups. Results 5,653,590 adults were included. 5,244,439 were normotensive and 409,151 were hypertensive patients defined by SBP/DBP ≥ 140/90mmHg or intaking antihypertensive medication. Primary endpoint, a composite of myocardial infarction (MI), heart failure (HF), stroke, and total death was significantly less in lower DBP group than in reference group of DBP≥110mmHg with linear pattern. Events per 10000 were 108 (DBP60mmHg), 122(60-69mmHg), 153(70-79mmHg), 227(80-89mmHg), 378(90-99mmHg), 581(100-109mmHg, and 1044 (≥110mmHg) with hazard ratio (HR, as compared to ≥110mmHg group ) of 0.24, 0.25, 0.27, 0.33, 0.44, 0.60, 1.0 with all p-values0.001. In individual outcomes, the lower DBP was associated with lower event rate. Among normotensives, event rates were 108(DBP60mmHg), 123(60-69mmHg), 158 (70-79mmHg) and 222 (80-90mmHg, reference) per 10000 person with HR of 0.75, 0.78, 0.85 and 1.0, respectively with all p-values0.001. Same trend was found in hypertensive patients. Conclusions Lower DBP was associated with better clinical outcomes in young adults irrespective of hypertension in 10-year follow-up. This relationship was linear and no J-phenomenon was detected. Low DBP in normal person and more lowered DBP in hypertensive patients can be a good prognostic marker and target in blood pressure management.
Jo et al. (2025) conducted a cohort in Hypertension (n=5,653,590). Diastolic blood pressure <60 mmHg vs. Diastolic blood pressure ≥110 mmHg was evaluated on composite of myocardial infarction (MI), heart failure (HF), stroke, and total death (HR 0.24, p=<0.001). Lower diastolic blood pressure (<60 mmHg) was associated with a significantly lower risk of MI, HF, stroke, and death compared to DBP ≥110 mmHg (HR 0.24; P<0.001) over 10 years.