Diastolic blood pressure
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Diastolic Blood Pressure: Insights and Implications
Global Trends in Diastolic Blood Pressure
Worldwide Trends and Regional Variations
From 1975 to 2015, global trends in diastolic blood pressure (DBP) have shown significant regional variations. High-income countries in the West and Asia Pacific have seen substantial decreases in both systolic and diastolic blood pressure, moving from some of the highest levels worldwide in 1975 to the lowest in 2015. Conversely, regions such as East and Southeast Asia, South Asia, Oceania, and sub-Saharan Africa have experienced increases in mean blood pressure levels. This shift highlights the changing epidemiology of hypertension and the need for targeted public health interventions in different regions.
Prevalence of Raised Blood Pressure
In 2015, the global age-standardized mean diastolic blood pressure was 78.7 mm Hg for men and 76.7 mm Hg for women. The prevalence of raised blood pressure (defined as DBP ≥ 90 mm Hg) was 24.1% in men and 20.1% in women. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the majority of this increase occurring in low- and middle-income countries.
Diastolic Blood Pressure and Cardiovascular Outcomes
Independent Predictor of Cardiovascular Events
Both systolic and diastolic hypertension independently predict adverse cardiovascular outcomes. A study involving 1.3 million adults found that continuous burdens of systolic hypertension (≥140 mm Hg) and diastolic hypertension (≥90 mm Hg) each independently predicted a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke. The hazard ratio per unit increase in z-score was 1.18 for systolic hypertension and 1.06 for diastolic hypertension, indicating that while systolic blood pressure has a greater effect, diastolic blood pressure also significantly influences cardiovascular risk.
Risks of Diastolic Hypotension
Excessive lowering of diastolic blood pressure can be harmful, particularly in patients undergoing intensive systolic blood pressure treatment. The Systolic Blood Pressure Intervention Trial (SPRINT) found that patients who developed diastolic hypotension (DBP < 55 mm Hg) had an increased risk of cardiovascular morbidity and all-cause mortality. This was true for both intensive and standard treatment arms, suggesting that attention to diastolic blood pressure is crucial when targeting systolic blood pressure reduction.
Diagnostic and Predictive Value of Diastolic Blood Pressure
Comparison with Systolic Blood Pressure
Historically, diastolic blood pressure has been used as a primary criterion for hypertension treatment. However, recent studies suggest that systolic blood pressure may be a more critical predictor of cardiovascular risk, especially in older adults. The Framingham Heart Study and other epidemiological data indicate that systolic pressure is more strongly associated with coronary heart disease and other cardiovascular events than diastolic pressure. This has led to calls for re-evaluating the reliance on diastolic blood pressure in hypertension management .
Mean Arterial Pressure as an Alternative
Mean arterial pressure (MAP), which averages arterial blood pressure throughout a cardiac cycle, may offer a more accurate assessment of hypertension's cerebrovascular impact than either systolic or diastolic blood pressure alone. Studies have shown that MAP is more beneficial in identifying cerebrovascular changes associated with hypertension, supporting its use as a superior index for hypertension diagnosis and research.
Conclusion
Diastolic blood pressure remains a significant factor in understanding and managing hypertension and its associated risks. While systolic blood pressure may have a more substantial impact on cardiovascular outcomes, diastolic blood pressure independently contributes to risk and should not be overlooked. The evolving understanding of blood pressure dynamics underscores the need for comprehensive approaches in hypertension diagnosis and treatment, considering both systolic and diastolic measures, as well as alternative indices like mean arterial pressure.
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