Lip, S. , Tan, L. E., Jeemon, P., McCallum, L., Dominiczak, A. F. and Padmanabhan, S. (2019) Diastolic blood pressure J-curve phenomenon in a tertiary-care hypertension clinic. Hypertension, 74(4), pp. 767-775. (doi: 10.1161/HYPERTENSIONAHA.119.12787) (PMID:31422693) (PMCID:PMC6756261)
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Abstract
Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18–1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17–1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Lip, Dr Stefanie and Mccallum, Dr Linsay and Padmanabhan, Professor Sandosh and Panniyammakal, Mr Jeemon and Dominiczak, Professor Anna |
Authors: | Lip, S., Tan, L. E., Jeemon, P., McCallum, L., Dominiczak, A. F., and Padmanabhan, S. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Hypertension |
Publisher: | American Heart Association |
ISSN: | 0194-911X |
ISSN (Online): | 1524-4563 |
Published Online: | 19 August 2019 |
Copyright Holders: | Copyright © 2019 The Authors |
First Published: | First published in Hypertension 74(4):767-775 |
Publisher Policy: | Reproduced under a Creative Commons License |
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