diastolic blood pressure (DBP)
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Introduction
Blood pressure when the left ventricle is relaxing, i.e. during diastole.
Clinical significance
- coronary perfusion takes places almost entirely during diastole
- autoregulation with dilation of the coronary arteries with diminishing diastolic blood pressure[8]
- in dogs coronary dilation completely compensates for decreased diastolic blood pressure down to 30-40 mm Hg in maintaining coronary perfusion[8]
- diastolic BP is the major if not exclusive determinant of coronary perfusion pressure & thus an important component of blood pressure assessment & hypertension management
high diastolic blood pressure
- systolic BP increases throughout the 7th decade of life, but diastolic BP plateaus in the 5th decade
- increased diastolic blood pressure is a less powerful predictor of most cardiovascular diseases than increased systolic blood pressure[7]*
- increased diastolic blood pressure is a better predictor of abdominal aortic aneurysm than increased systolic blood pressure[7]*
low diastolic blood pressure
- J-shaped curve observed for diastolic blood pressure & cardiovascular disease & mortality[10]
- no trial has directly looked at the J-poin relationship[10]
- optimal diatolic BP minimizing mortality is 84 mm Hg
- lowest mortality associated with diastolic BP of 70-89 mm Hg in patients with chronic renal failure[6]
- no evidence for a J-shaped curve with the lowest diastolic BP associated with increased risk[7]*
- people with the lowest BP levels (90-114)/(60-74) mm Hg with the lowest risk for cardiovascular disease[7]*
- association of blood pressure with cardiovascular disease decreases with increasing age[7]*
- AHA/ACA/ASH question the idea of J point[8]
- ref[8] cites conflicting data
- increased incidence of MI with diastolic blood pressure < 80 mm Hg
- no such correlation, same data, different analysis
- lowest incidence of cardiovascular events in patients with diastolic BP of 60-65 mm Hg[8] (from study that found no benefit in lowering BP to < 120/80 mm Hg in diabetics)
- no increase in mortality with diastolic blood pressureas low as 50 mm Hg in hypertensive patients with coronary artery disease[9]
- ref[8] cites conflicting data
- low diastolic BP & increased pulse pressure is associated with increased all-cause death & myocardial infarction, but not stroke[1][2][4][10]
- low diastolic BP & increased pulse pressure is associated with subclinical myocardial damage & CHD events[12]
- lowest mortality with systolic pressure < 130 mm Hg & diastolic pressure 80-89 mm Hg[11]
- diastolic BP < 60 mm Hg associated with increased risk of cardiovascular events when systolic BP treated to < 130 mm Hg; optimal diastolic BP 70-80 mm Hg[13]
* huge study, adults age 30 & older, 5 year follow-up
See diastole & systolic hypertension.
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, Kolloch R, Benetos A, Pepine CJ. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006 Jun 20;144(12):884-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16785477
- ↑ 2.0 2.1 Somes GW et al, The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 159:2004, 1999 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10510985
- ↑ Boutitie J et al The J shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 136:438, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11900496
- ↑ 4.0 4.1 Ungar A et al, Low diastolic ambulatory blood pressure is associated with greater all-cause mortality in older patients with hypertension. J Am Geriatr Soc. 2009 Feb;57(2):291-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19207144
- ↑ Bangalore S, Messerli FH, Wun CC et al J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J. 2010 Dec;31(23):2897-908 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20846991
- ↑ 6.0 6.1 Kovesdy CP et al Blood Pressure and Mortality in U.S. Veterans With Chronic Kidney Disease: A Cohort Study. Ann Intern Med. 2013;159(4):233-242 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24026256 <Internet> http://annals.org/article.aspx?articleid=1726794
Rifkin DE and Sarnak MJ How Low Can You Go? Blood Pressure and Mortality in Chronic Kidney Disease Ann Intern Med. 2013;159(4):302-303. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24026262 <Internet> http://annals.org/article.aspx?articleid=1726833 - ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Rapsomaniki E et al Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1 25 million people. The Lancet, Volume 383, Issue 9932, pg 1899-1911, 31 May 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24881994 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960685-1/abstract#
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Rosendorff C et al Treatment of Hypertension in Patients With Coronary Artery Disease. A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension. 2015 Mar 31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25828847 <Internet> http://hyper.ahajournals.org/content/early/2015/03/30/HYP.0000000000000018
- ↑ 9.0 9.1 Messerli FH, Mancia G, Conti CR et al Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884-893. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16785477
- ↑ 10.0 10.1 10.2 10.3 Argulian E, Grossman E, Messerli FH Misconceptions and Facts about Treating Hypertension. American Journal of Medicine, 2015 128:450-455 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25486449
Panjrath GS1, Chaudhari S, Messerli FH. The j-point phenomenon in aggressive therapy of hypertension: new insights. Curr Atheroscler Rep. 2012 Apr;14(2):124-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22396196
Banach M, Aronow WS Blood Pressure J Curve current concepts. Curr Hypertens Rep 2012. 14:556-566 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23054894
Kaplan NM The diastolic J curve: alive and threatening. Hypertension. 2011 58:751-753 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21911707
Zanchetti A Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. Eur Heart J 2010 31:2837-2840 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20980328 - ↑ 11.0 11.1 Glynn RJ, Chae CU, Guralnik JM et al Pulse Pressure and Mortality in Older People. Arch Intern Med. 2000;160(18):2765-2772 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/11025786 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=485457
- ↑ 12.0 12.1 McEvoy JW, Chen Y, Rawlings A et al Diastolic Blood Pressure, Subclinical Myocardial Damage, and Cardiac Events: Implications for Blood Pressure Control. J Am Coll Cardiol. 2016 Oct 18;68(16):1713-1722. PMID: https://www.ncbi.nlm.nih.gov/pubmed/7590090
- ↑ 13.0 13.1 Li J, Somers VK, Gao X et al Evaluation of Optimal Diastolic Blood Pressure Range Among Adults With Treated Systolic Blood Pressure Less Than 130 mm Hg. JAMA Netw Open. 2021;4(2):e2037554 Feb 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33595663 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776530