Can Diastolic Blood Pressure be Excessively Lowered in the Treatment of Isolated Systolic Hypertension?

In older populations, and those with prevalent cardiovascular disease, there is increasing evidence that reducing diastolic blood pressure below a level of 80-85 mm Hg is associated with increased risk of cardiovascular end points and all cause mortality. We sought to confirm this finding in participants in Systolic Hypertension in the Elderly Program, a placebo controlled trial of blood pressure reduction in older adults with isolated systolic hypertension. We found that, among subjects randomized to active treatment, for each 5 mm Hg lower achieved value in diastolic blood pressure increases the risk for stroke by 14%, coronary heart disease by 8%, and all cardiovascular disease 11%. This effect was not observed in the placebo group. Significant increases in cardiovascular disease risk were especially noted among patients for whom diastolic blood pressure was 60 mm Hg. This brief report suggests that older persons who develop large drops in diastolic blood pressure while undergoing treatment for isolated systolic hypertension may deserve special monitoring. (c)2000 by Le Jacq Communications, Inc.