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. 2022 Sep 1;35(9):795-802.
doi: 10.1093/ajh/hpac056.

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

Bernhard Haring  1   2   3 , Aileen P McGinn  3 , Victor Kamensky  3 , Matthew Allison  4 , Marcia L Stefanick  5 , Peter F Schnatz  6 , Lewis H Kuller  7 , Jeffrey S Berger  8 , Karen C Johnson  9 , Nazmus Saquib  10 , Lorena Garcia  11 , Phyllis A Richey  9 , JoAnn E Manson  12 , Michael Alderman  3 , Sylvia Wassertheil-Smoller  3
Affiliations

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

Bernhard Haring et al. Am J Hypertens. .

Abstract

Background: Recommended systolic blood pressure 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 blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models.

Results: After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg 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 mm Hg may avoid higher mortality risk.

Keywords: blood pressure; cardiovascular disease; diastolic blood pressure; hypertension; mortality; older women.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Hazard ratios (95% confidence interval) of death for levels of DBP compared with a DBP of 80 mm Hg. Controlling for age, race, and ethnicity, antihypertensive medication, history of stroke or CHD, SBP, and SBP2. Orange line: hazard ratios; gray dotted line: upper limit of 95% confidence interval; blue dotted line: lower limit of 95% confidence interval. Abbreviations: CHD, coronary heart disease; DBP, diastolic blood pressure; SBP, systolic blood pressure.
Figure 2.
Figure 2.
Hazard ratios (95% confidence interval) of composite CVD for levels of DBP compared with a DBP of 80 mm Hg. Controlling for age, race, antihypertensive meds, SBP, SBP2, DBP, and DBP2. Blue line: hazard ratios; yellow dotted line: upper limit of 95% confidence interval; orange dotted line: lower limit of 95% confidence interval. Abbreviations: CVD, cardiovascular disease; DBP, diastolic blood pressure; SBP, systolic blood pressure.
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