Associations Between Systolic and Diastolic BP and Cardiovascular Outcomes

Fifty years ago, diastolic blood pressure (BP) was thought to be more predictive of adverse cardiovascular (CV) events than systolic BP, but epidemiologic studies eventually overturned that idea. More recently, systolic BP has been deemed more important, although both systolic and diastolic BP targets are recommended in guidelines (NEJM JW Gen Med Dec 15 2017 and J Am Coll Cardiol 2018; 71:e127). Now, researchers have explored relations between BP and 8-year CV outcomes (myocardial infarction or stroke) in more than 1 million adults (median age, 53) from northern California's Kaiser Permanente health system. The analysis used weighted averages of each person's BP measurements (median, 22 measurements per person) during the 8-year observatio…