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Diastolic Hypotension in a Tertiary Care Hypertension Clinic: Have We Gone Too Far?
Trevor Mace-Brickman1, Wilder Leduc1, Swapnil Hiremath1
1Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital Ottawa, Canada; Kidney Research Centre, Ottawa Health Research Institute, Ottawa, Canada.
Insights
Treatment for high systolic blood pressure can lead to diastolic hypotension, a condition where diastolic blood pressure drops too low. Older patients, those with diabetes, and individuals with isolated systolic hypertension are more prone to developing this condition.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Research
Background:
- Diastolic hypotension is linked to adverse cardiovascular events.
- Tertiary care hypertension clinics manage complex patient cases.
Purpose of the Study:
- To determine the prevalence of diastolic hypotension in patients at a hypertension clinic.
- To identify risk factors associated with developing diastolic hypotension during treatment.
Main Methods:
- Retrospective chart review of 466 patients.
- Definition of diastolic hypotension as diastolic blood pressure < 60 mm Hg.
- Comparison of blood pressure before and after achieving systolic blood pressure targets.
Main Results:
- 10.5% of patients had baseline diastolic hypotension; 16% acquired it during follow-up.
- Development of diastolic hypotension occurred in 27% of patients treated for systolic hypertension.
- Older age, diabetes, higher baseline systolic BP, and lower baseline diastolic BP predicted diastolic hypotension.
Conclusions:
- Treating systolic hypertension can induce diastolic hypotension.
- Patients with diabetes, older age, and isolated systolic hypertension are at higher risk.
- Diastolic hypotension often persists without reduction in antihypertensive therapy.
Background:
Treatment-induced diastolic hypotension has been associated with an increased risk of adverse cardiovascular events in post hoc analyses of major blood pressure (BP)-lowering trials. We undertook this retrospective study to assess the prevalence and risk factors for diastolic hypotension among patients referred to a tertiary care hypertension clinic.
Methods:
Charts of all active patients were reviewed, and BP at the initial visit was compared with BP at the first visit at which the systolic BP target was achieved or the last visit if the target was not achieved. Diastolic hypotension was defined as diastolic BP < 60 mm Hg.
Results:
Four hundred sixty-six patients were identified. The mean baseline BP was 142/77 mm Hg, and the mean number of medications was 2.9. Forty-nine (10.5%) patients had diastolic hypotension at baseline, and a further 68 (16%) acquired it during follow-up. Those with baseline diastolic hypotension had no change in the number of antihypertensive medications being taken on follow-up (mean, 3.6-3.7; P = 0.46), and diastolic BP did not change (53-55 mm Hg; P = 0.07). On adjusted analysis, older age (odds ratio [OR], 1.04; P = 0.0008), diabetes (OR, 2.8; P = 0.002), higher baseline systolic BP (OR, 1.03; P < 0.001), and lower baseline diastolic BP (OR, 0.003; P < 0.001) were predictors of diastolic hypotension at follow-up.
Conclusions:
Treating systolic hypertension resulted in diastolic hypotension in 27% of patients followed at a tertiary care hypertension clinic. Its presence does not usually result in the reduction of antihypertensive therapy. Older patients, patients with diabetes, and patients with isolated systolic hypertension appear to be more susceptible to the development of diastolic hypotension during therapy.
