Low Diastolic Ambulatory Blood Pressure Is Associated with Greater All‐Cause Mortality in Older Patients with Hypertension

Ungar, Andrea; Pepe, Giuseppe; Lambertucci, L.; Fedeli, A.; Monami, Matteo; Mannucci, Edoardo; Gabbani, Luciano; Masotti, Giulio; Marchionni, Niccolò; Bari, Mauro Di

doi:10.1111/j.1532-5415.2008.02123.x

Cited by 53 publications

(36 citation statements)

References 25 publications

(31 reference statements)

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“…The phenomenon of increased mortality with intensive reduction of DBP in individuals aged ⩾ 65 years has been demonstrated in various studies, 13,30 and a pathophysiological basis for the Figure 3. Association of SBP and all-cause mortality, stratified by walking speed.…”

Section: Discussionmentioning

confidence: 96%

Walking speed and high blood pressure mortality risk in a Spanish elderly population

et al. 2015

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This study analyzed the relationship between blood pressure and all-cause mortality according to objectively measured walking speed in a Mediterranean population-based sample of older persons. We used data from the longitudinal 'Peñagrande' Cohort Study, initiated in 2008 in a sex- and age-stratified random sample of 1250 people aged ⩾65 years living in Madrid (Spain). A total of 814 individuals participated in the first study wave. The average of two standardized blood pressure readings was used. Walking speed was measured over a 3-m walk and classified as faster (⩾0.8 m s(-1)) or slower. A total of 314 individuals were slower walkers, 475 were faster walkers and 25 did not complete the walk test. Cox proportional hazards models stratified by walking speed were used to assess the association between blood pressure and all-cause death. Non-linear relationship between BP and mortality was explored by a restricted cubic spline analysis. There were 171 deaths from study entry through 31 March 2013. Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mmHg were associated with higher mortality than blood pressure values above 140 and 90 mm Hg, respectively, but this association reached statistical significance only for systolic blood pressure and only in the slower walkers. In conclusion, systolic blood pressure levels <140 mm Hg were found associated with higher risk of total mortality among slower walkers in an old Spaniard population cohort.

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Section: Discussionmentioning

confidence: 96%

Walking speed and high blood pressure mortality risk in a Spanish elderly population

et al. 2015

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“…Furthermore, advanced age, female sex, and diabetes mellitus, but not treatment status, were associated with low DBP. Similarly, Ungar et al 17 showed that low ambulatory DBP was associated with greater all-cause mortality in older patients with ISH after adjusting for antihypertensive treatment and other covariates. The Framingham Heart Study 14 showed that a DBP of <70 mm Hg versus DBP 70 to 89 mm Hg in the absence of antihypertensive therapy could add a risk equivalent of ≈20 mm Hg of increase in SBP-in other words, a potential risk-equivalent shift from prehypertension to stage 1 systolic hypertension or from stage 1 to stage 2 systolic hypertension.…”

Section: Discussionmentioning

confidence: 99%

Does Low Diastolic Blood Pressure Contribute to the Risk of Recurrent Hypertensive Cardiovascular Disease Events?

et al. 2015

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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)

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“…14 Some, but not all, studies including elderly persons have shown associations of lower DBP with higher risk for cardiovascular events and death. 7,15–17 Whether measures of functional status can identify the elders in whom low DBP is associated with increased risk cardiovascular events and death has not been well established.…”

Section: Introductionmentioning

confidence: 99%

Systolic and Diastolic Blood Pressure, Incident Cardiovascular Events, and Death in Elderly Persons

et al. 2014

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Whether limitation in ability to perform activities of daily living (ADL) or gait speed can identify elders in whom the association of systolic (SBP) and diastolic (DBP) blood pressure with cardiovascular events (CVD) and death differs is unclear. We evaluated whether limitation in ADL or gait speed modify the association of SBP or DBP with incident CVD (N= 2,358) and death (N=3,547) in the Cardiovascular Health Study. Mean age was 78 ± 5 and 21% reported limitation in ≥1 ADL. There were 778 CV events and 1,289 deaths over 9 years. Among persons without and with ADL limitation, SBP was associated with incident CVD: HR (per 10 mmHg increase) 1.08 (95% CI 1.03, 1.13) and 1.06 (0.97, 1.17), respectively. ADL modified the association of DBP with incident CVD. Among those without ADL limitation, DBP was weakly associated with incident CVD, HR 1.04 (0.79, 1.37) for DBP > 80, compared with <65 mmHg. Among those with ADL limitation, DBP was inversely associated with CVD: HR 0.65 (0.44, 0.96) for DBP 66–80 mmHg and HR 0.49 (0.25, 0.94) for DBP > 80, compared to DBP ≤ 65. Among persons with ADL limitation, a DBP 66–80 had the lowest risk for death, HR 0.72 (0.57, 0.91), compared with DBP ≤ 65. Associations did not vary by 15 feet walking speed ADL can identify elders in whom diastolic hypotension is associated with higher CV risk and death. Functional status, rather than chronologic age alone, should inform design of hypertension trials in elders.

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Low Diastolic Ambulatory Blood Pressure Is Associated with Greater All‐Cause Mortality in Older Patients with Hypertension

Abstract: In older patients with hypertension, low DBP and high PP, particularly when measured using ambulatory BP monitoring, are associated with greater risk of death. The achievement of an SBP treatment goal should not be obtained at the expense of an excessive DBP reduction.

Cited by 53 publications

References 25 publications

Walking speed and high blood pressure mortality risk in a Spanish elderly population

Walking speed and high blood pressure mortality risk in a Spanish elderly population

Does Low Diastolic Blood Pressure Contribute to the Risk of Recurrent Hypertensive Cardiovascular Disease Events?

Systolic and Diastolic Blood Pressure, Incident Cardiovascular Events, and Death in Elderly Persons

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