Systolic, Diastolic HTN Contribute to Adverse CV Events

Both systolic and diastolic hypertension contribute independently to the risk for adverse cardiovascular events, according to a study published in the issue of the New England Journal of Medicine.

Alexander C. Flint, M.D., Ph.D., from Kaiser Permanente Northern California in Oakland, and colleagues used data from 1.3 million adults in a general outpatient population to examine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke during eight years.

The researchers found that adverse outcomes were independently predicted by the burdens of systolic and diastolic hypertension. A continuous burden of systolic hypertension (≥140 mm Hg) and diastolic hypertension (≥90 mm Hg) independently predicted the composite outcome in survival models (hazard ratio per unit increase in z score, 1.18 and 1.06, respectively). The results were similar with lower thresholds of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. There was a J-curve relation between diastolic blood pressure and outcomes; this finding was partially explained by age and other covariates and by a higher effect of systolic hypertension among individuals in the lowest diastolic blood pressure quartile.

"Both systolic and diastolic hypertension contribute significantly to cardiovascular risk, regardless of the threshold used for hypertension (≥140/90 mm Hg or ≥130/80 mm Hg)," the authors write.

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