Clinical implications of the diastolic blood pressure 'J Curve' in treated hypertensive patients

Lip, S. , McCallum, L., Touyz, R.H. , Dominiczak, A.F. and Padmanabhan, S. (2015) Clinical implications of the diastolic blood pressure 'J Curve' in treated hypertensive patients. Journal of Hypertension, 33(Supl 1), e87. (doi: 10.1097/01.hjh.0000467584.81358.e3) (PMID:26102953)

Abstract

Objective: Recent studies have shown that low diastolic blood pressure is associated with increased cardiovascular outcomes especially in those with pre-existing cardiovascular disease (DBP ’J’ Curve). Whether this has practical implications in real life hypertension practice is unknown. Design and method: We analysed the achieved blood pressure of 6,072 patients between years 2 and 5 following initial presentation to the Glasgow Blood Pressure Clinic. Patients were classified into nine groups based on the area under the curve(AUC) of at least 3 blood pressure(BP) readings during this period. Multivariable adjusted 30 years survival analysis was performed using Cox proportional hazards model. Results: The age of first visit was 53±13 years, BMI 27.6 ± 5.2, baseline BP 169 ± 29/100 ± 18 mmHg, 52% were females, 60% drank more than 6 units of alcohol/week, 44% were ever smokers, 26% had prevalent CVD and 26% had eGFR<60. Of 6,072 individuals, 418(7%) achieved AUC-BP =<140/80; 365(12%) had isolated systolic hypertension(ISH) (>140/<80mmHg) of whom 98 had severe ISH (SBP>160/ DBP<80). There were only 199(0.7%) subjects with AUC-DBP<70 mmHg. 30 year survival data was available for 5,451 individuals with 1,662 allcause deaths and 65,430 person-years of follow-up. Figure 1 presents the adjusted hazard ratios for cardiovascular mortality showing significant excess risk associated with DBP<80 only in subjects with SBP>160. Conclusions: In treated hypertensive patients, the DBP ’J ’curve is not apparent with achieved BP 2 - 5 years from presentation. This may be explained partly by the low likelihood of achieving DBP<70 2-5 years after commencing treatment.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lip, Dr Stefanie and Mccallum, Dr Linsay and Padmanabhan, Professor Sandosh and Dominiczak, Professor Anna and Touyz, Professor Rhian
• Authors: Lip, S., McCallum, L., Touyz, R.H., Dominiczak, A.F., and Padmanabhan, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Hypertension
• Publisher: Lippincott Williams & Wilkins
• ISSN: 0263-6352
• ISSN (Online): 1473-5598