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Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients

Steven Tringali1, Charles William Oberer, Jian Huang

  • 1Department of Medicine, Veterans Administration Central California Health Care System, 2615 E Clinton Avenue, Fresno, CA 93703, USA ; Department of Medicine, University of California, San Francisco, Fresno Medical Education Program, 155 N Fresno Avenue, Fresno, CA 93701, USA.

International Journal of Hypertension
|April 23, 2013
PubMed

Insights

Lowering diastolic blood pressure (DBP) below 70 mmHg is linked to increased mortality. This finding suggests a need for minimum blood pressure targets in hypertension guidelines to avoid adverse cardiovascular events.

Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Public Health

Background:

  • Intensive lowering of diastolic blood pressure (DBP) has been paradoxically linked to increased cardiovascular events.
  • The observed J-curve phenomenon challenges aggressive blood pressure reduction, particularly in patients with coronary artery disease.

Purpose of the Study:

  • To investigate the association between low diastolic blood pressure (DBP) and all-cause mortality.
  • To determine a safe lower threshold for DBP in patient management.

Main Methods:

  • Analysis of a two-year cross-section of primary care veteran patients aged 45-85.
  • Utilized Receiver Operating Characteristics (ROC) to identify optimal DBP cut-off points.
  • Employed propensity-score matching and multivariate logistic regression to control for confounding factors.

Main Results:

  • A DBP threshold of 70 mmHg showed the strongest association with mortality (P < 0.001).
  • Nearly half (49%) of the studied patients had a DBP of 70 mmHg or lower.
  • A DBP below 70 mmHg was associated with a 1.5-fold increased odds of all-cause mortality (95% CI 1.3-1.8).

Conclusions:

  • Reducing diastolic blood pressure (DBP) below 70 mmHg is associated with elevated all-cause mortality.
  • Current hypertension guidelines should incorporate a minimum blood pressure target to prevent harm.

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