F or >30 years, 1,2 there has been controversy regarding the clinical significance of low diastolic blood pressure (DBP) in patients treated for hypertension because it relates to increased cardiovascular disease (CVD) risk in general and to coronary heart disease (CHD) risk in particular. This has not been studied in those with pre-existing CVD, a population with greater risk than those without initial events. Therefore, in the present study, we limited our investigation to persons who survived an initial CVD event-CHD, heart failure (HF), or stroke. We divided these persons into 2 groups: (1) those with isolated systolic hypertension (ISH; systolic blood pressure [SBP] ≥140 and DBP <90 mm Hg) with DBP 70 to 89 mm Hg, in the presence or absence of antihypertensive treatment; these persons are at higher risk because of widened pulse pressure and increased arterial stiffness [3][4][5] ; and (2) persons with ISH with a low mean arterial pressure that is associated with a low DBP, ie, <70 mm Hg in the absence or presence of antihypertensive treatment 6,7 ; we hypothesized that group 2 persons would be at even higher risk than group 1.We addressed the following questions in the present investigation: First, is there increased risk for recurrent CVD events in individuals with a DBP of <70 mm Hg versus those with a DBP 70 to 89 mm Hg in those with ISH, regardless of the presence or absence of antihypertensive treatment? Second, is there increased risk for individual CVD components examined separately (CHD, HF, or stroke events) in the presence versus absence of antihypertensive treatment in individuals with a DBP of <70 mm Hg versus a DBP 70 to 89 mm Hg? Third, can we judge the relative importance of wide pulse pressure versus low DBP in predicting CVD events? Methods OverviewThe Framingham Heart Study began in 1948 enrolling 5209 men and women, 30 to 62 years of age who underwent repeated examinations biennially. [8][9][10] In 1971, 5124 men and women who were children or the spouses of children of the original Framingham Heart Study were 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)

Asian subgroup-specific information on type 2 diabetes mellitus (DM) is scarce. Using the California Health Interview Survey 2007 data, we examined Chinese, Korean, Japanese, Filipinos, and Vietnamese adults (n = 3,688) and Caucasian adults (n = 33,981) for the prevalence of DM and risk factors. The age-adjusted prevalence of DM was the highest among Filipinos (8.05%) followed by Japanese (7.07%), Vietnamese (7.03%), and Koreans (6.3%). Chinese (5.93%) was the only Asian group studied whose prevalence was lower than Caucasians (5.94%). From multiple logistic regression, after adjusting for risk factors, Japanese had the highest likelihood of DM (OR = 1.75, CI = [1.12–2.73], P < 0.05), followed by Filipinos (1.66, [1.13–2.43], P < 0.01), and Koreans (1.59, [1.00–2.52], P < 0.05), relative to Caucasians. Our results suggest that even after accounting for lifestyle and other risk factor differences between Caucasians and key Asian subgroups in California, Japanese, Filipinos, and Koreans have a 1.6–1.75 greater likelihood of DM compared to Caucasians.

There is a wide variation in CVD risk in persons with HTN with control rates still suboptimal in higher risk subjects. Future guidelines should consider risk stratification combining shorter and longer-term risk assessment to best identify those who have the greatest CVD risk.