Effect of Low Diastolic Blood Pressure to Cardiovascular Risk in Patients With Ischemic Stroke or Transient Ischemic Attacks Under Different Systolic Blood Pressure Levels

Abstract

Background: In the context of recently updated strategies of pressure management, there is a paucity of evidence on the effect of diastolic blood pressure (DBP) level on adverse events among stroke patients. This study aimed to examine the effect of low DBP (<60 mmHg) under different levels of systolic blood pressure (SBP) on the risk of composite events and stroke recurrence among patients with ischemic stroke (IS) or transient ischemic attack (TIA).Material and Methods: This study was conducted in 2,325 patients with IS or TIA. DBP values were categorized into <60, 60-70, 70-80 (reference), 80-90, and ≥90 mmHg in the main sample and were further categorized as <60 and ≥60 mmHg (reference) when patients were stratified according to SBP levels (<140, <130, and <120 mmHg). The outcomes were defined as recurrent stroke and cumulative composite events (defined as the combination of nonfatal myocardial infarction, nonfatal congestive heart failure, and death) at 1 year.Results: During 1 year of follow-up, a total of 95 composite events and 138 stroke recurrences were identified. The patients with low DBP showed a significantly higher risk of composite events [hazard ratio (HR) = 4.86, 95% confidence interval (CI) = 2.54-8.52], especially the elderly patients (≥60 years); however, this result was not observed for stroke recurrence (HR = 0.90, 95% CI = 0.46-1.74). With the reduction of the SBP levels, the proportion of patients with low DBP increased (6.87, 12.67, and 34.46%), and the risk for composite events persisted.Conclusions: Along with the new target levels of SBP suggested by updated criteria, there is a trend for DBP to be reduced to a harmfully low level, which was associated with an increased risk of composite events among patients with IS or TIA.

The optimal pulse pressures for healthy adults with different ages and sexes correlate with cardiovascular health metrics

“…Conversely, several earlier studies suggested that lower DBP or intensive DBP reduction may increase the risk of coronary artery disease (23,24). A recent study further suggests that low DBP (<60 mmHg) was associated with an increased risk of composite events among patients aged 20 years or older, with ischemic stroke or transient ischemic attack (25). In a population of veterans aged 45 or older, reduction of DBP below 70 mmHg was associated with increased all-cause mortality (26).…”

Left Ventricular Diastolic Dysfunction as Predictor of Unfavorable Prognosis After ESUS

“…However, the study failed to find an analogical trend for stroke recurrence. 23 In our study, patients who died had significantly lower DBP than patients who survived.…”

Is the KDIGO Systolic Blood Pressure Target <120 mm Hg for Chronic Kidney Disease Appropriate in Routine Clinical Practice?

“…Although the KDIGO guideline does not stipulate a diastolic target, in attempting to lower SBP <120 mm Hg in patients with CKD, there is also the risk of driving diastolic BP too low especially in older patients, who often have low diastolic BP because of advanced atherosclerosis. 27 Diastolic BP is important for adequate coronary artery filling. Many studies have demonstrated that low diastolic BP <70 mm Hg is associated with higher risk of CVD, recurrent CV events, and stroke compared with diastolic BP between 71 and 89 mm Hg.…”

“…Many studies have demonstrated that low diastolic BP <70 mm Hg is associated with higher risk of CVD, recurrent CV events, and stroke compared with diastolic BP between 71 and 89 mm Hg. [27][28][29][30] People with CKD already have a high risk of CVD. 4 The practice points of the KDIGO guideline in relation to the target BP recommendation highlight the potential hazards associated with the low BP target and suggest that clinicians can reasonably offer less intensive BP lowering therapy in those with symptomatic postural hypotension.…”

“…Many studies have demonstrated that low diastolic BP <70 mm Hg is associated with higher risk of CVD, recurrent CV events, and stroke compared with diastolic BP between 71 and 89 mm Hg. 27–30 People with CKD already have a high risk of CVD. 4…”