Reconsidering the cut-off diastolic blood pressure for predicting cardiovascular events: a nationwide...

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.