Bernhard Haring1,2,3, Aileen P McGinn3, Victor Kamensky3, Matthew Allison4, Marcia L Stefanick5, Peter F Schnatz6, Lewis H Kuller7, Jeffrey S Berger8, Karen C Johnson9, Nazmus Saquib10, Lorena Garcia11, Phyllis A Richey9, JoAnn E Manson12, Michael Alderman3, Sylvia Wassertheil-Smoller3. 1. Department of Medicine III, Saarland University Hospital, Homburg, Germany. 2. Department of Medicine I, University of Würzburg, Würzburg, Germany. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA. 4. Department of Family Medicine, University of California San Diego, La Jolla, California, USA. 5. Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA. 6. Department of Obstetrics/Gynecology and Internal Medicine, Reading Hospital/Tower Health, West Reading, Pennsylvania, USA. 7. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 8. Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York, USA. 9. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA. 10. College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia. 11. Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California, USA. 12. Department of Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Recommended systolic blood pressure targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities. We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS). METHODS: The study sample included 7,875 women (mean age: 79 years) who underwent a blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models. RESULTS: After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg overall. CONCLUSIONS: In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mm Hg may avoid higher mortality risk.
BACKGROUND: Recommended systolic blood pressure targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities. We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS). METHODS: The study sample included 7,875 women (mean age: 79 years) who underwent a blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models. RESULTS: After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg overall. CONCLUSIONS: In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mm Hg may avoid higher mortality risk.
Authors: Stanley S Franklin; Sohum S Gokhale; Vincent H Chow; Martin G Larson; Daniel Levy; Ramachandran S Vasan; Gary F Mitchell; Nathan D Wong Journal: Hypertension Date: 2014-11-24 Impact factor: 10.190
Authors: Robert H Fagard; Jan A Staessen; Lutgarde Thijs; Hilde Celis; Christopher J Bulpitt; Peter W de Leeuw; Gastone Leonetti; Jaakko Tuomilehto; Yair Yodfat Journal: Arch Intern Med Date: 2007-09-24
Authors: Eva M Lonn; Jackie Bosch; Patricio López-Jaramillo; Jun Zhu; Lisheng Liu; Prem Pais; Rafael Diaz; Denis Xavier; Karen Sliwa; Antonio Dans; Alvaro Avezum; Leopoldo S Piegas; Katalin Keltai; Matyas Keltai; Irina Chazova; Ron J G Peters; Claes Held; Khalid Yusoff; Basil S Lewis; Petr Jansky; Alexander Parkhomenko; Kamlesh Khunti; William D Toff; Christopher M Reid; John Varigos; Lawrence A Leiter; Dora I Molina; Robert McKelvie; Janice Pogue; Joanne Wilkinson; Hyejung Jung; Gilles Dagenais; Salim Yusuf Journal: N Engl J Med Date: 2016-04-02 Impact factor: 91.245