Diastolic blood pressure J-curve phenomenon in a tertiary-care hypertension clinic

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
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lip, Miss Stefanie and Padmanabhan, Professor Sandosh and Panniyammakal, Mr Jeemon and Dominiczak, Professor Anna and McCallum, Dr Linsay
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 > Institute of Cardiovascular and Medical Sciences
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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