Harlan M. Krumholz, MD, SM reviewing McEvoy JW et al. J Am Coll Cardiol 2016 Oct 18.

An analysis of observational data links low diastolic blood pressures to increased risk for heart disease in people with systolic blood pressures ≥120, raising questions about the impact of medically lowering SBP.

With all the attention on target systolic blood pressure (SBP), diastolic blood pressure (DBP) is often relegated to a footnote. However, there are concerns that lowering a patient's SBP may affect coronary perfusion pressure by reducing the DBP. Investigators evaluated possible links of DBP to adverse outcomes and myocardial damage in an analysis of 21 years of data from the ARIC study, a prospective observational cohort.

Of the 11,565 adults studied here, 57% were female, and 25% were black (mean baseline age, 57). Participants with the two lowest levels of DBP (<60 mm Hg and 60–69 mm Hg) were more likely than those with DBPs of 80 to 89 mm Hg to have a high-sensitivity cardiac troponin-T (hs-cTNT) level ≥14 ng/L. DBPs <65 mm Hg had a linear inverse relationship with hs-cTNT levels. In addition, DBP <60 mm Hg was associated with a higher risk for coronary heart disease and mortality. The association was stronger for myocardial infarction and fatal coronary heart disease. The excess risk was most prominent in participants with an SBP of ≥120 mm Hg (i.e., with a pulse pressure >60 mm Hg).

CITATION(S):

McEvoy JW et al. Diastolic blood pressure, subclinical myocardial damage, and cardiac events: Implications for blood pressure control. J Am Coll Cardiol 2016 Oct 18; 68:1713. 

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