Diastolic Blood Pressure J-Curve Phenomenon in a Tertiary-Care Hypertension Clinic

Author:

Lip Stefanie1,Tan Li En1,Jeemon Panniyammakal12,McCallum Linsay1,Dominiczak Anna F.1,Padmanabhan Sandosh1

Affiliation:

1. From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.L., L.E.T., P.J., L.M., A.F.D., S.P.)

2. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India (P.J.).

Abstract

Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18–1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17–1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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