Association of Hypertension With Mortality

To the Editor: Gu et al.,1 in their article published in the January issue of AJH titled “Association of Hypertension Treatment and Control With All-Cause and Cardiovascular Disease Mortality Among US Adults With Hypertension” reported that the mortality risk linearly increased with systolic blood pressure (SBP), pulse pressure, and mean arterial pressure; whereas the diastolic blood pressure (DBP) was not a significant predictor of outcome. This study fell short in exploring important data particularly in regards to the geriatric population. It is well known that most people of less than 50 years of age with hypertension have elevated DBP; and as SBP continues to rise with age, the DBP tends to fall.2 The overall poor hypertension control is mostly attributable to inadequate management of SBP.3 Although there is compelling reason to treat SBP,4 this becomes a dilemma for the physicians who treat the geriatric population because it is a balancing act not to lower the DBP too low. Recent studies5,6 indicate that reaching a goal off SBP at the expense of excessive reduction of DBP may increase mortality, particularly in cases of isolated systolic hypertension. Therefore, the authors of the study should analyze the data of elderly subjects to see true association of DBP, if any, with morbidity and mortality outcome.