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Study: Don't forget the other BP number



Systolic and diastolic blood pressures both contribute to cardiovascular disease, a study showed.

Over the 75th percentile, both systolic blood pressure (HR 1.40, 95% CI 1.38-1.43) and diastolic blood pressure (HR 1.22, 95% CI 1.20-1.24) predicted poor results regardless of demographics and cohabitation relationships, investigators led by Alexander Flint, doctoral student in Kaiser Permanente Northern California, reported in Oakland.

New and old hypertension thresholds confirmed the higher blood pressure of the compound at higher risk of the combined risk of MI, ischemic stroke and hemorrhagic stroke in multivariable Cox regression analyzes:

  • Systolic hypertension (≥140 mm Hg): HR 1
    .18 per increase of unit in standard z-score (95% CI 1.17-1.18)
  • Diastolic hypertension (> 90 mm Hg): HR 1.06 (95% CI 1.06-1.07)
  • ] Diastolic hypertension (≥80 mm Hg): HR 1.08 (95% CI 1.06-1.09)

"Although systolic blood pressure elevation had a greater effect on results, both systolic and diastolic hypertension independently affected the risk of adverse cardiovascular events, independently of the definition of high blood pressure (≥140 / 90 mm Hg or ≥130 / 80 mm Hg), "the authors wrote in the New England Journal of Medicine .

Therefore, "diastolic blood pressure should not be ignored," they said, adding that their findings supported recent guideline changes to switch to the lower blood pressure target.

A J-curve of diastolic blood pressure was seen in the assay, so there was a higher risk of negative results at both high and low values. [19659002] "We found that the J curve was at least partially explained by the relationship to age and other covariates; In addition, we found that systolic hypertension had a greater effect in the group of participants with lower diastolic blood pressure, an observation previously reported explaining the J curve", reported the investigators.

For the study, Flint's group access to the electronic records of the Kaiser Permanente Northern California healthcare system was more than 1.3 million adults who had blood pressure measurements in the outpatient clinic.

There were more than 36 million blood pressure measurements available, all of which had been taken with automated blood pressure cuff.

Side effects were noted during an 8-year observation period. During that time, the predicted risk was the following for mean blood pressure:

  • Systolic blood pressure about 160 mm Hg: 4.8% [19659005] Systolic blood pressure about 136 mm Hg: 1.9%
  • Diastolic blood pressure about 96 mm Hg : 3.6%
  • Diastolic blood pressure about 81 mm Hg: 1.9%

Limit study of the retrospective study did not include the count of death in the primary result and missing cholesterol data.

However, the study is still important given the importance of both systolic and diastolic blood pressure in future cardiovascular risk, according to Monika Sanghavi, MD, of Penn Heart and the Vascular Center in Philadelphia, which was not part of Flint's group.

"Since the emphasis moves from clinical blood pressure measurements to ambulatory blood pressure measurements in the diagnosis of hypertension, there is confusion about the threshold values ​​for diagnosis. This study supports the idea that a lower threshold for diagnosing hypertension> 130/80 mmHg may be appropriate, as it also is a strong prediction for negative cardiovascular diseases, she told MedPage Today .

The study was supported by an institutional contribution.

Flint revealed no conflicts of interest.

2019-07-18T12: 30: 36-0400


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