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Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients
Background. A paradoxical increase in cardiovascular events has been reported with intensively lowering diastolic blood pressure (DBP). This J-curve phenomenon has challenged the aggressive lowering of blood pressure, especially in patients with coronary artery disease. Objective. Our objective was...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi Publishing Corporation
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623464/ https://www.ncbi.nlm.nih.gov/pubmed/23606946 http://dx.doi.org/10.1155/2013/178780 |
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author | Tringali, Steven Oberer, Charles William Huang, Jian |
author_facet | Tringali, Steven Oberer, Charles William Huang, Jian |
author_sort | Tringali, Steven |
collection | PubMed |
description | Background. A paradoxical increase in cardiovascular events has been reported with intensively lowering diastolic blood pressure (DBP). This J-curve phenomenon has challenged the aggressive lowering of blood pressure, especially in patients with coronary artery disease. Objective. Our objective was to study the effects of low DBP on mortality and determine a threshold for which DBP should not be lowered beyond. Methods. We evaluated a two-year cross-section of primary care veteran patients, from 45 to 85 years of age. Receiver operating characteristics (ROC) were employed to establish an optimal cut-off point for DBP. Propensity-score matching and multivariate logistic regression were used to control for confounders. All-cause mortality was the primary outcome. Results. 14,270 patients were studied. An ROC curve found a threshold value of DBP 70 mmHg had the greatest association with mortality (P < 0.001). 49% of patients had a DBP of 70 mmHg or less. Using a propensity-matched multivariate logistic regression, odds ratio for all-cause mortality in subjects with a DBP less than 70 mmHg was 1.5 (95% CI 1.3–1.8). Conclusions. Reduction of DBP below 70 mmHg is associated with increased all-cause mortality. Hypertension guidelines should include a minimum blood pressure target. |
format | Online Article Text |
id | pubmed-3623464 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Hindawi Publishing Corporation |
record_format | MEDLINE/PubMed |
spelling | pubmed-36234642013-04-19 Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients Tringali, Steven Oberer, Charles William Huang, Jian Int J Hypertens Research Article Background. A paradoxical increase in cardiovascular events has been reported with intensively lowering diastolic blood pressure (DBP). This J-curve phenomenon has challenged the aggressive lowering of blood pressure, especially in patients with coronary artery disease. Objective. Our objective was to study the effects of low DBP on mortality and determine a threshold for which DBP should not be lowered beyond. Methods. We evaluated a two-year cross-section of primary care veteran patients, from 45 to 85 years of age. Receiver operating characteristics (ROC) were employed to establish an optimal cut-off point for DBP. Propensity-score matching and multivariate logistic regression were used to control for confounders. All-cause mortality was the primary outcome. Results. 14,270 patients were studied. An ROC curve found a threshold value of DBP 70 mmHg had the greatest association with mortality (P < 0.001). 49% of patients had a DBP of 70 mmHg or less. Using a propensity-matched multivariate logistic regression, odds ratio for all-cause mortality in subjects with a DBP less than 70 mmHg was 1.5 (95% CI 1.3–1.8). Conclusions. Reduction of DBP below 70 mmHg is associated with increased all-cause mortality. Hypertension guidelines should include a minimum blood pressure target. Hindawi Publishing Corporation 2013 2013-03-27 /pmc/articles/PMC3623464/ /pubmed/23606946 http://dx.doi.org/10.1155/2013/178780 Text en Copyright © 2013 Steven Tringali et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Tringali, Steven Oberer, Charles William Huang, Jian Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title | Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title_full | Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title_fullStr | Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title_full_unstemmed | Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title_short | Low Diastolic Blood Pressure as a Risk for All-Cause Mortality in VA Patients |
title_sort | low diastolic blood pressure as a risk for all-cause mortality in va patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623464/ https://www.ncbi.nlm.nih.gov/pubmed/23606946 http://dx.doi.org/10.1155/2013/178780 |
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