Not afraid of low diastolic blood pressure anymore?

blood pressure (SBP) is the most important factor influencing cardiovascular risk. The results of clinical studies including the Systolic Blood Pressure Intervention Trial (SPRINT) [1] preceded the changes in blood pressure goals proposed by hypertension societies. SPRINT showed that intensive lowering of the SBP to a goal of <120 mmHg could be beneficial and safe in contrast to the standard goal up to that point of <140 mmHg. In practice, it is unlikely that the SBP can be lowered without simultaneously reducing diastolic blood pressure (DBP). This may then limit how tightly the SBP can be controlled. For more than 30 years, investigators have argued as to whether lowering DBP increases the risk of myocardial infarction and coronary artery disease in patients with hypertension. From a pathophysiologic perspective, a low DBP may adversely affect myocardial perfusion because, unlike in other vascular beds, blood flow in the epicardial coronary arteries is maintained during diastole [2]. It is therefore reasonable to postulate that the positive effect on cardiovascular risk of achieving a low SBP target may be blunted by the increased hazard associated with a low DBP. Such concept was proven right in various studies however analysis of large population-based trials of individuals with high cardiovascular risk have been ambiguous. Ongoing analysis of SPRINT findings has indicated that the increased cardiovascular risk in for participants with a low DBP may be explained by factors other than simply the DBP, such as higher age and higher prevalence of cardiovascular or chronic kidney disease. This suggests that a low DBP is not an independent risk factor for cardiovascular events [3, 4]. This also seems to be the case in other studies of subjects with high cardiovascular risk [5]. In contrast to this view, however, analysis of the ONTARGET and TRANSCEND findings indicate that the benefit of intensive lowering of SBP may be limited because of concomitant DBP reduction [6]. Similar conclusions have been drawn by other investigators analyzing the SPRINT results showing that a DBP <55 mmHg recorded at a single visit was responsible for attenuation of the benefits of SBP reduction in both of the trial’s treatment arms [7]. Thus, the discussion regarding the influence of lowering the DBP continues. The results being highlighted here do not apply to all age Editorial