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Reconsidering the cut-off diastolic blood pressure for predicting cardiovascular events: a nationwide
You-Jung Choi1,2, Sun-Hwa Kim1, Si-Hyuck Kang1,2
1Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, Korea.
Insights
The study found that cardiovascular risk is lowest at blood pressure (BP) levels of 90-99/40-49 mmHg, with risk increasing linearly above this. Diastolic BP below 80 mmHg showed minimal risk difference, suggesting current hypertension definitions may need adjustment.
Area of Science:
- Cardiology
- Hypertension Research
- Epidemiology
Background:
- Elevated blood pressure (BP) is a significant risk factor for major cardiovascular events.
- The precise relationship between lower BP ranges and cardiovascular risk, particularly the existence of a J-curve, remains debated.
- Understanding the independent predictive value of systolic and diastolic BP is crucial for accurate cardiovascular risk assessment.
Purpose of the Study:
- To investigate the association between systolic and diastolic blood pressure (BP) and major cardiovascular events.
- To determine if a J-curve association exists in cardiovascular risk prediction.
- To clarify the independent predictive power of systolic and diastolic BP in cardiovascular outcomes.
Main Methods:
- Utilized data from the National Health Insurance Services Health Screening Cohort, including antihypertensive medication-naïve subjects.
- Defined the study endpoint as a composite of cardiac death, myocardial infarction, stroke, and heart failure.
- Analyzed data from 290,600 subjects with a median follow-up of 6.7 years.
Main Results:
- The lowest risk for major cardiovascular events was observed at systolic BP of 90-99 mmHg and diastolic BP of 40-49 mmHg.
- Above these levels, BP demonstrated a log-linear relationship with increased cardiovascular event risk.
- Diastolic BP prediction was inconsistent when stratified by systolic BP; wider pulse pressure was more significant in older men. The risk difference between diastolic BP <80 mmHg and 80-89 mmHg diminished after adjustments.
Conclusions:
- The log-linear association between BP and cardiovascular events extends down to 90/40 mmHg.
- The current hypertension definition's diastolic BP threshold of ≥80 mmHg appears disproportionately low compared to systolic BP thresholds.
- Findings suggest a re-evaluation of diastolic BP targets in hypertension management may be warranted.
Aims:
It is unclear whether a J-curve association exists in cardiovascular risk prediction and how independently systolic and diastolic blood pressure (BP) predict cardiovascular outcomes. This study evaluated the association of systolic and diastolic BP with major cardiovascular events to clarify these issues.
Methods And Results:
Antihypertensive medication-naïve subjects with available BP measurements and no history of cardiovascular events were extracted from the National Health Insurance Services Health Screening Cohort. The study endpoint was a composite of cardiac death, myocardial infarction, stroke, and heart failure. The study population comprised 290 600 subjects (median follow-up duration 6.7 years). The risk for major cardiovascular events was lowest at systolic and diastolic BPs of 90-99 mmHg and 40-49 mmHg, respectively, above which BPs demonstrated a log-linear risk prediction. Systolic and diastolic BPs were highly correlated. The risk prediction of diastolic BP was inconsistent when stratified by systolic BP. A wider pulse pressure rather than a higher diastolic BP was significantly associated with cardiovascular outcomes among men aged ≥55 years. In addition, the difference between diastolic BPs of <80 mmHg and 80-89 mmHg mostly disappeared after statistical adjustment or stratification.
Conclusion:
Elevated BP is a strong predictor of future cardiovascular events including cardiac death, myocardial infarction, stroke, and heart failure. This study showed that the log-linear relationship between BP and cardiovascular events extended down to a BP of ≥90/40 mmHg. Although hypertension is defined using a lower systolic BP cut-off of ≥130 mmHg, the diastolic BP component of ≥80 mmHg seems disproportionately low.
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