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Atherosclerosis. 2014 Mar;233(1):300-6. doi: 10.1016/j.atherosclerosis.2014.01.004. Epub 2014 Jan 21.

Diastolic blood pressure, aortic atheroma, and prognosis in hypertension: new insights into a complex association.

Author information

1
Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, EA 4173, Université Claude Bernard Lyon1, F-69100 Villeurbanne, France; Hôpital Nord-Ouest, F-69400 Villefranche sur Saône, France. Electronic address: pycourand@hotmail.com.
2
Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France.
3
Génomique Fonctionnelle de l'Hypertension artérielle, EA 4173, Université Claude Bernard Lyon1, F-69100 Villeurbanne, France; Hôpital Nord-Ouest, F-69400 Villefranche sur Saône, France.
4
Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France; Génomique Fonctionnelle de l'Hypertension artérielle, EA 4173, Université Claude Bernard Lyon1, F-69100 Villeurbanne, France; Hôpital Nord-Ouest, F-69400 Villefranche sur Saône, France.

Abstract

OBJECTIVES:

Our study aimed at determining the interaction between the prognostic value of diastolic blood pressure (DBP) and aortic atherosclerosis (ATS).

BACKGROUND:

With aging, equal systolic blood pressures (SBPs) become associated with low DBPs; i.e., high pulse pressures (PPs) become associated with a high risk of cardiovascular death. This association is usually ascribed to aortic stiffening with age but the precise impact of low DBP per se is yet uncertain.

METHODS:

938 hypertensive patients recruited in the seventies had an aortic ATS score at pretreatment aortography. All-cause and cardiovascular deaths were assessed 20 years later. The prognostic values of DBP and SBP were assessed by a multivariate Cox regression model and their interactions with ATS examined.

RESULTS:

In the presence of ATS, an increase of 10 mmHg in DBP was associated with a protective effect: hazard ratios 0.84 [0.72-0.99] for cardiovascular death and 0.88 [0.78-1.00] for all-cause death. However, in the absence of ATS, DBP had no prognostic value: hazard ratios 1.05 [0.89-1.23] for cardiovascular death and 0.99 [0.88-1.11] for all-cause death (p for interaction: 0.061 and 0.087, respectively). No interaction was found between SBP and ATS (p for interaction > 0.40).

CONCLUSIONS:

The prognostic values of DBP and aortic atheroma are not superimposable; yet, they are tightly connected: a low DBP is disadvantageous only in the presence of a pathologic aorta. Aortic atherosclerosis may explain, at least partly, in some high risk populations, the J-shape of the already reported DBP-outcome relationship.

KEYWORDS:

Aortic atherosclerosis; Cardiovascular death; Diastolic blood pressure; Systolic blood pressure

[Indexed for MEDLINE]

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