Related Experiment Video

Updated: Jul 11, 2026

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
04:37

Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension

Published on: June 6, 2025

On-treatment diastolic blood pressure and prognosis in systolic hypertension

Robert H Fagard1, Jan A Staessen, Lutgarde Thijs

  • 1Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, B-3000 Leuven, Belgium. robert.fagard@uz.kuleuven.ac.be

Archives of Internal Medicine
|September 26, 2007
PubMed

Insights

Low diastolic blood pressure (BP) in older adults on antihypertensive treatment increases noncardiovascular mortality. Careful BP management is crucial, especially for those with coronary heart disease.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Trials

Background:

  • Investigating the potential harm of low diastolic blood pressure (BP) in older patients with systolic hypertension receiving antihypertensive treatment.
  • Examining the association between on-treatment diastolic BP, mortality, and cardiovascular events.

Purpose of the Study:

  • To assess the relationship between on-treatment diastolic BP and adverse outcomes in elderly patients with systolic hypertension.
  • To determine the safety threshold for diastolic BP during antihypertensive therapy.

Main Methods:

  • Prospective, placebo-controlled trial (Systolic Hypertension in Europe Trial) involving elderly patients with systolic hypertension.
  • Randomization into a double-blind first phase, followed by active treatment for all patients.
  • Multivariate Cox regression analysis to evaluate outcomes based on on-treatment diastolic BP during placebo and active treatment phases.

Main Results:

  • Noncardiovascular mortality increased with lower diastolic BP in both placebo and active treatment groups.
  • Low diastolic BP during active treatment was linked to an increased risk of cardiovascular events, particularly in patients with pre-existing coronary heart disease.
  • Hazard ratios indicated a significant increase in mortality and events with decreasing diastolic BP levels.

Conclusions:

  • Antihypertensive treatment intensification is supported to prevent cardiovascular events in older systolic hypertension patients until diastolic BP reaches 55 mm Hg.
  • A cautious approach is advised for patients with coronary heart disease, suggesting diastolic BP should not be lowered below 70 mm Hg.
Abstract

Related Concept Videos

Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
Hypertension I: Introduction01:28

Hypertension I: Introduction

Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
Antihypertensive Drugs: Action of Diuretics01:16

Antihypertensive Drugs: Action of Diuretics

Diuretics are antihypertensive drugs used to treat hypertension resulting from sodium and water retention. Sodium, vital for fluid balance and nerve or muscle function, is regulated by the kidneys through millions of nephrons. Blood enters nephrons via afferent arterioles, which branch into capillaries called glomeruli. These filter blood plasma, allowing water and solutes, like sodium ions, to pass through capillary walls into Bowman's capsule. The filtrate then flows through various tubules...
Hypertension V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...