Low Diastolic Blood Pressure and Mortality in Older Women. Results from the Women's Health Initiative Long Life Study.

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BACKGROUND: Recommended systolic blood pressure (SBP) targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities.We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS).

METHODS: The study sample included 7,875 women (mean age: 79 years) who underwent a BP measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HR) were obtained from adjusted Cox proportional hazards models.

RESULTS: After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared to a DBP of 80 mmHg, the fully adjusted hazards ratio (HR) for mortality was 1.33 (95% CI: 1.04-1.71) for a DBP of 50 mmHg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mmHg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mmHg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mmHg. The nadir DBP associated with lowest mortality risk was 72 mmHg overall.

CONCLUSIONS: In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mmHg may avoid higher mortality risk.

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American journal of hypertension : journal of the American Society of Hypertension





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Online ahead of print.