High diastolic blood pressure
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High Diastolic Blood Pressure: Implications and Trends
Introduction to High Diastolic Blood Pressure
High diastolic blood pressure (DBP), defined as a DBP of 90 mm Hg or higher, is a significant health concern. It is a critical component of hypertension, which is a major risk factor for cardiovascular diseases (CVD) and chronic kidney disease1. Understanding the trends, implications, and management strategies for high DBP is essential for improving public health outcomes.
Global Trends in Diastolic Blood Pressure
Historical and Regional Trends
From 1975 to 2015, global trends in diastolic blood pressure 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 20151. Conversely, regions such as East and Southeast Asia, South Asia, Oceania, and sub-Saharan Africa have experienced increases in mean blood pressure levels1. This shift highlights the growing burden of hypertension in low- and middle-income countries.
Prevalence and Population Impact
The prevalence of raised blood pressure, including high DBP, has decreased in high-income and some middle-income countries but remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, primarily due to population growth and aging in low- and middle-income countries1.
Health Implications of High Diastolic Blood Pressure
Cardiovascular Risks
High DBP is associated with an increased risk of major cardiovascular events, including mortality. Studies have shown that elevated DBP, even when systolic blood pressure (SBP) targets are achieved, is linked to a higher risk of stroke and other cardiovascular outcomes7. This underscores the importance of managing both systolic and diastolic blood pressure to mitigate cardiovascular risks.
Acute Stroke Outcomes
In the context of acute stroke, high DBP is significantly associated with poor outcomes, including death, dependency, and deterioration. Elevated DBP in acute ischemic stroke or primary intracerebral hemorrhage (PICH) is linked to higher odds of death and combined death or dependency4. These findings suggest that moderate lowering of blood pressure in acute stroke patients might improve outcomes.
Management and Treatment Guidelines
Evolving Guidelines
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines provide updated recommendations for the definition and management of hypertension, including specific thresholds for DBP2. These guidelines emphasize the importance of achieving target blood pressure goals to reduce the risk of cardiovascular events.
Treatment Strategies
For patients with high DBP, especially those who have achieved SBP targets, it is crucial to consider both systolic and diastolic measurements in treatment plans. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends lifestyle modifications and the use of antihypertensive medications, such as thiazide diuretics, to manage hypertension effectively3. Additionally, achieving a DBP of 70 to <80 mm Hg is associated with the lowest cardiovascular risk, while both lower and higher DBP levels are linked to increased risks10.
Conclusion
High diastolic blood pressure remains a critical factor in the global burden of hypertension and its associated health risks. While significant progress has been made in high-income countries, low- and middle-income regions continue to face rising blood pressure levels. Effective management strategies, including adherence to updated guidelines and comprehensive treatment plans, are essential for reducing the cardiovascular risks associated with high DBP. Continued research and public health efforts are needed to address this ongoing challenge and improve outcomes for individuals worldwide.
Sources and full results
Most relevant research papers on this topic
Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants
From 1975 to 2015, the highest worldwide blood pressure levels have shifted to central and eastern Europe, sub-Saharan Africa, and south Asia, with the global increase in the number of adults with raised blood pressure largely in low-income and middle-income countries.
Meta-Analysis
Rigorous Journal
Highly CitedPotential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline
The 2017 ACC/AHA High Blood Pressure Guideline recommends systolic and diastolic blood pressure thresholds for initiation of antihypertensive medication and target goals for BP management in adults.
Rigorous JournalHighly CitedSeventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
The seventh report highlights the importance of lifestyle modifications, thiazide diuretics, and other antihypertensive drugs for managing high blood pressure, emphasizing the importance of patient motivation and satisfaction.
Highly CitedHigh blood pressure in acute stroke and subsequent outcome: a systematic review.
High blood pressure in acute stroke patients is associated with increased death, death or dependency, and deterioration, suggesting that lowering blood pressure may improve outcomes.
Systematic ReviewHighly CitedA historical perspective of elevated systolic vs diastolic blood pressure from an epidemiological and clinical trial viewpoint.
Elevated systolic blood pressure is a greater predictor of coronary heart disease mortality than diastolic blood pressure, and using diastolic blood pressure as the sole treatment criterion should be reevaluated.
Highly CitedElevated systolic blood pressure and risk of cardiovascular and renal disease: overview of evidence from observational epidemiologic studies and randomized controlled trials.
Systolic blood pressure is an independent and strong predictor of the risk of cardiovascular and renal diseases, with a reduction of 12-13 mm Hg in systolic blood pressure over 4 years being associated with a 21% reduction in coronary heart disease, 37% reduction in stroke, 25% reduction in total cardiovascular
Systematic ReviewHighly CitedElevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets
Elevated on-treatment diastolic blood pressure is associated with a high risk of major cardiovascular events and mortality, even when achieved systolic blood pressure targets.
Observational StudyRigorous JournalGenetic analysis of over 1 million people identifies 535 new loci associated with blood pressure traits
535 new blood pressure loci have been identified, offering new insights into blood pressure regulation and highlighting shared genetic architecture between blood pressure and lifestyle exposures.
Observational StudyRigorous JournalHighly CitedElevated systolic blood pressure as a cardiovascular risk factor.
Elevated systolic blood pressure is a more valuable measurement in evaluating and controlling hypertension than diastolic blood pressure, with stronger influence on cardiovascular risk than diastolic blood pressure.
Literature ReviewHighly CitedAchieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120–140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
Achieving a target diastolic blood pressure of 70 to 80 mmHg is associated with the lowest cardiovascular risk in high-risk patients, while a lower diastolic blood pressure (70 mmHg) increases the risk of stroke, heart failure, and all-cause death
Highly Cited