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diastolic blood pressure (DBP)

Blood pressure when the left ventricle is relaxing, i.e. during diastole. Clinical significance: physiology - 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 - after adjusting for comorbities, optimum moved to 74 mm Hg [1] - 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] - 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.

Related

diastole systolic blood pressure (SBP)

General

blood pressure (BP)

References

  1. 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: 16785477
  2. Somes GW et al, The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 159:2004, 1999 PMID: 10510985
  3. 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: 11900496
  4. 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: 19207144
  5. 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: 20846991
  6. 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 PMID: 24026256 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. PMID: 24026262 http://annals.org/article.aspx?articleid=1726833
  7. 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 PMID: 24881994 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960685-1/abstract#
  8. 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 PMID: 25828847 http://hyper.ahajournals.org/content/early/2015/03/30/HYP.0000000000000018
  9. 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: 16785477
  10. Argulian E, Grossman E, Messerli FH Misconceptions and Facts about Treating Hypertension. American Journal of Medicine, 2015 128:450-455 PMID: 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: 22396196 - Banach M, Aronow WS Blood Pressure J Curve current concepts. Curr Hypertens Rep 2012. 14:556-566 PMID: 23054894 - Kaplan NM The diastolic J curve: alive and threatening. Hypertension. 2011 58:751-753 PMID: 21911707 - Zanchetti A Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. Eur Heart J 2010 31:2837-2840 PMID: 20980328
  11. Glynn RJ, Chae CU, Guralnik JM et al Pulse Pressure and Mortality in Older People. Arch Intern Med. 2000;160(18):2765-2772 PMID: 11025786 http://archinte.jamanetwork.com/article.aspx?articleid=485457
  12. 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: 7590090
  13. 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: 33595663 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776530