Diastolic Blood Pressure, Subclinical Myocardial Damage, and Cardiac Events

“The take-home message is there is increased likelihood that if we use blood pressure drugs to push patients' systolic blood pressures down to 120, which is a strategy supported by recent clinical trials, the consequence in those starting out with low diastolic blood pressures (e.g., below 80) may be that the diastolic number falls so low that we risk doing damage.”

“If individuals have a diastolic blood pressure that is too low, there might not be enough blood flow to the heart muscle itself, and this could lead to subclinical elevations in troponin. Perhaps then, over time, it's not just subclinical elevations in troponin but [low DBP] is causing actual damage to the heart muscle. It's a way of putting it all together—there's no way of proving all that. It should be pointed out that both ARIC and CLARIFY are observational analyses. These are not randomized blood-pressure trials.”

“We saw, in fact, that individuals that started off with a low diastolic blood pressure, even as low as 60 [mm Hg],... had lower risk for cardiovascular disease and MI over the course of their life. The inference from that is that the diastolic blood pressure J-curve may have little to do with diastolic blood pressure itself and more to do with other parameters like vascular stiffness or vascular calcification that are the true culprits.”