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Low Diastolic Blood Pressure Risk in Hypertension (page 299)
This community-based Framingham Heart Study is the first to show that people with an initial cardiovascular disease (CVD) event and persistent isolated systolic hypertension in combination with diastolic blood pressure (DBP) <70 mm Hg versus DBP 70 to 89 mm Hg had increased risk for recurrent CVD events, largely independent of antihypertensive treatment. These findings support wide pulse pressure (≥68 mm Hg) in combination with DBP <70 mm Hg as important CVD risk factors (see Figure). Thus, early vascular aging may be an effect modifier that increases pulse pressure and decreases DBP as central elastic arteries stiffen, resulting in premature isolated systolic hypertension. Second, recurrent CVD event risk may be related to low diastolic perfusion pressure, but only when associated with wide pulse pressure as a measure of increased elastic …