Does Low Diastolic Blood Pressure Contribute to the Risk of Recurrent Hypertensive Cardiovascular Disease Events?. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Franklin, Stanley S.; Gokhale, Sohum S.; Chow, Vincent H.; Larson, Martin G.; Levy, Daniel; Vasan, Ramachandran S.; Mitchell, Gary F.; Wong, Nathan D.
• Is Part Of: Hypertension. Volume 65:Issue 2(2015:Feb.)
• Publication Date: 2015-02
• Subjects: Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.114.04581
• Languages: English
• ISSNs: 0194-911X

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <p>Whether low diastolic blood pressure (DBP) is a risk factor for recurrent cardiovascular disease (CVD) events in persons with isolated systolic hypertension is controversial. We studied 791 individuals (mean age 75 years, 47% female, mean follow-up time: 8±6 years) with DBP <70 (n=225) versus 70 to 89 mm Hg (n=566) after initial CVD events in the original and offspring cohorts of the Framingham Heart Study. Recurrent CVD events occurred in 153 (68%) participants with lower DBP and 271 (48%) with higher DBP (<italic>P</italic><0.0001). Risk of recurrent CVD events in risk factor-adjusted Cox regression was higher in those with DBP <70 mm Hg versus DBP 70 to 89 mm Hg in both treated (hazard ratio, 5.1 [95% confidence interval: 3.8–6.9] <italic>P</italic><0.0001) and untreated individuals (hazard ratio, 11.7 [95% confidence interval: 6.5–21.1] <italic>P</italic><0.0001; treatment interaction: <italic>P</italic>=0.71). Individually, coronary heart disease, heart failure, and stroke recurrent events were more likely with DBP <70 mm Hg versus 70 to 89 mm Hg (<italic>P</italic><0.0001). To examine for an effect of wide pulse pressure on excess risk associated with low DBP, we defined 4 binary groupings of pulse pressure (≥68 versus <68 mm Hg) and DBP (<70 versus 70–89 mm Hg). CVD incidence rates were higher only in the group with pulse pressure ≥68 and DBP <70 mm Hg (76% versus 46%–54%; <italic>P</italic><0.001). Persons with isolated systolic hypertension and prior CVD events have increased risk for recurrent CVD events in the presence of DBP <70 mm Hg versus DBP 70 to 89 mm Hg, whether treated or untreated, supporting wide pulse pressure as an important risk modifier for the adverse effect of low DBP.</p> </sec> </abstract>