Dr KK Aggarwal
Research
has shown that high systolic BP is more associated with adverse outcomes compared to high
diastolic BP. But, now a new study has shown that both
systolic and diastolic hypertension independently influence the risk of adverse
cardiovascular events, regardless of the definition of hypertension (≥140/90 mm
Hg or ≥130/80 mm Hg), although increase in systolic BP had a greater effect on
outcomes.
In the study reported in the
New England Journal of Medicine, online July 18, 2019, researchers analysed more than 36 million BP readings from 1.3 million
adults in a general outpatient population to determine the effect of the burden
of systolic and diastolic hypertension on a composite outcome of myocardial
infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years.
· In
survival models, a continuous burden of systolic hypertension (≥140 mm Hg;
hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI],
1.17 to 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit
increase in z score, 1.06; 95% CI, 1.06 to 1.07) independently predicted the
composite outcome.
· Similar
results were observed with the lower threshold of hypertension (≥130/80 mm Hg)
and with systolic and diastolic BP used as predictors without hypertension thresholds.
· A
J-curve relation between diastolic BP and outcomes was seen that was explained
at least in part by age and other covariates and by a higher effect of systolic
hypertension among persons in the lowest quartile of diastolic BP.
“This
analysis using a very large amount of longitudinal data convincingly
demonstrates that both are important, and it shows that in people who are
otherwise generally healthy, lower blood pressure numbers are better,” Said Deepak
L. Bhatt, MD, MPH senior author of the study and,
executive director of Interventional Cardiovascular Services at Brigham and
Women’s Hospital and professor of medicine at Harvard Medical School
(Source: N Engl J Med. 2019
Jul 18;381(3):243-251; Kaiser Permanente)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
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