Treated Diastolic Blood Pressure: How Low Is Too Low?

By Christine Judge

Edited by David G. Fairchild, MD, MPH, and Richard Saitz, MD, MPH, FACP, DFASAM

Lowering diastolic blood pressure (DBP) to under 60 mm Hg is associated with increased risk for adverse cardiovascular (CV) events, according to a JAMA Network Open study. Current U.S. guidelines recommend a blood pressure target of under 130/80 mm Hg but don't specify a lower DBP limit.

Researchers conducted a post hoc analysis of data from some 7500 adult participants of recent blood pressure intervention trials (SPRINT and ACCORD-BP) who achieved a treated systolic blood pressure (SBP) <130 mm Hg.

Patients treated to a DBP level <60 mm Hg had significantly increased risks for the primary outcome (all-cause death, nonfatal myocardial infarction (MI), and nonfatal stroke; hazard ratio, 1.46), a composite cardiovascular outcome (CV death, nonfatal MI, and nonfatal stroke; HR, 1.74), nonfatal MI (1.73), and nonfatal stroke (2.67), compared with those with a DBP of 70 to <80. A treated DBP of 70 to <80 was associated with the lowest risks. Results were similar in analyses adjusting for systolic blood pressure.

The authors suggest that findings "only serve as a caution regarding lowering DBP to less than 60 mm Hg and as an important hypothesis to be tested in future prospective studies regarding safe and optimal DBP ranges."