title: Does low diastolic blood pressure contribute to the risk of recurrent hypertensive cardiovascular disease events? The Framingham Heart Study.
abstract: Whether low diastolic blood pressure (DBP) is a risk factor for recurrent cardiovascular disease (CVD) events in persons with isolated systolic hypertension is controversial. We studied 791 individuals (mean age 75 years, 47% female, mean follow-up time: 8±6 years) with DBP <70 (n=225) versus 70 to 89 mm Hg (n=566) after initial CVD events in the original and offspring cohorts of the Framingham Heart Study. Recurrent CVD events occurred in 153 (68%) participants with lower DBP and 271 (48%) with higher DBP (P<0.0001). Risk of recurrent CVD events in risk factor-adjusted Cox regression was higher in those with DBP <70 mm Hg versus DBP 70 to 89 mm Hg in both treated (hazard ratio, 5.1 [95% confidence interval: 3.8-6.9] P<0.0001) and untreated individuals (hazard ratio, 11.7 [95% confidence interval: 6.5-21.1] P<0.0001; treatment interaction: P=0.71). Individually, coronary heart disease, heart failure, and stroke recurrent events were more likely with DBP <70 mm Hg versus 70 to 89 mm Hg (P<0.0001). To examine for an effect of wide pulse pressure on excess risk associated with low DBP, we defined 4 binary groupings of pulse pressure (≥68 versus <68 mm Hg) and DBP (<70 versus 70-89 mm Hg). CVD incidence rates were higher only in the group with pulse pressure ≥68 and DBP <70 mm Hg (76% versus 46%-54%; P<0.001). Persons with isolated systolic hypertension and prior CVD events have increased risk for recurrent CVD events in the presence of DBP <70 mm Hg versus DBP 70 to 89 mm Hg, whether treated or untreated, supporting wide pulse pressure as an important risk modifier for the adverse effect of low DBP.
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.). ssfranklinmd@earthlink.net.
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Franklin
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Sohum S
authors.initials: SS
authors.lastname: Gokhale
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Vincent H
authors.initials: VH
authors.lastname: Chow
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: From the Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine (S.S.F., S.S.G., V.H.C., N.D.W.); Framingham Heart Study, MA (M.G.L., D.L., R.S.V., G.F.M.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); Departments of Biostatistics (M.G.L.) and Epidemiology (R.S.V.), Boston University School of Public Health, MA; Population Sciences Branch, National Heart, Lung and Blood Institute, Bethesda, MD (D.L.); and Sections of Preventive Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, MA (R.S.V.).
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012907:Smoking / Q000453:epidemiology / Q000503:physiopathology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013599:Systole / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cardiovascular disease; epidemiology