Does low diastolic blood pressure contribute to the risk of recurrent hypertensive cardiovascular disease events? The framingham heart study

Stanley S. Franklin, Sohum S. Gokhale, Vincent H. Chow, Martin G. Larson, Daniel Levy, Ramachandran S. Vasan, Gary F. Mitchell, Nathan D. Wong

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Whether low diastolic blood pressure (DBP) is a risk factor for recurrent cardiovascular disease (CVD) events in persons with isolated systolic hypertension is controversial. We studied 791 individuals (mean age 75 years, 47% female, mean follow-up time: 8±6 years) with DBP <70 (n=225) versus 70 to 89 mm Hg (n=566) after initial CVD events in the original and offspring cohorts of the Framingham Heart Study. Recurrent CVD events occurred in 153 (68%) participants with lower DBP and 271 (48%) with higher DBP (P<0.0001). Risk of recurrent CVD events in risk factor-adjusted Cox regression was higher in those with DBP <70 mm Hg versus DBP 70 to 89 mm Hg in both treated (hazard ratio, 5.1 [95% confidence interval: 3.8-6.9] P<0.0001) and untreated individuals (hazard ratio, 11.7 [95% confidence interval: 6.5-21.1] P<0.0001; treatment interaction: P=0.71). Individually, coronary heart disease, heart failure, and stroke recurrent events were more likely with DBP <70 mm Hg versus 70 to 89 mm Hg (P<0.0001). To examine for an effect of wide pulse pressure on excess risk associated with low DBP, we defined 4 binary groupings of pulse pressure (68 versus <68 mm Hg) and DBP (<70 versus 70-89 mm Hg). CVD incidence rates were higher only in the group with pulse pressure 68 and DBP <70 mm Hg (76% versus 46%-54%; P<0.001). Persons with isolated systolic hypertension and prior CVD events have increased risk for recurrent CVD events in the presence of DBP <70 mm Hg versus DBP 70 to 89 mm Hg, whether treated or untreated, supporting wide pulse pressure as an important risk modifier for the adverse effect of low DBP.

Original languageEnglish (US)
Pages (from-to)299-305
Number of pages7
JournalHypertension
Volume65
Issue number2
DOIs
StatePublished - Feb 21 2015
Externally publishedYes

Keywords

  • blood pressure
  • cardiovascular disease
  • epidemiology

ASJC Scopus subject areas

  • Internal Medicine

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