ArticleHypertension (Dallas, Tex. : 1979)2019
Diastolic Blood Pressure J-Curve Phenomenon in a Tertiary-Care Hypertension Clinic.
Article in Hypertension (Dallas, Tex. : 1979), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed.
- Efficacy and safety of intensive antihypertensive strategy in patients with low diastolic blood pressure: a secondary analysis of a cluster randomised trial.Heart (British Cardiac Society) · 2026Trial
- Influence of baseline arterial stiffness on effects of intensive compared with standard blood pressure control: a post hoc analysis of the STEP trial.BMC medicine · 2022Trial
- Association Between Admission Blood Pressure and In-hospital Mortality and Long-term Mortality of Patients With ST-elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A China Acute Myocardial Infarction Registry Study.Reviews in cardiovascular medicine · 2025Article
- Pitfalls in Developing Machine Learning Models for Predicting Cardiovascular Diseases: Challenge and Solutions.Journal of medical Internet research · 2024Article
- Low on-treatment blood pressure and cardiovascular events in patients without elevated risk: a nationwide cohort study.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Article
- Assessing Machine Learning for Diagnostic Classification of Hypertension Types Identified by Ambulatory Blood Pressure Monitoring.CJC open · 2024Article
- Disability level's impact on blood pressure-mortality association in older long-term care adults: evidence from a large Chinese cohort study.BMC geriatrics · 2024Article
- Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction.Global heart · 2024Article
- Identifying Who Benefits the Most from a Community Health Worker-Led Multicomponent Intervention for Hypertension.International journal of hypertension · 2024Article
- Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fraction.The Korean journal of internal medicine · 2023Article
- Myocardial injury is a risk factor for 6-week mortality in liver cirrhosis associated esophagogastric variceal bleeding.Scientific reports · 2023Article
- Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care.BMC primary care · 2023Article
- Answering Clinical Questions Using Machine Learning: Should We Look at Diastolic Blood Pressure When Tailoring Blood Pressure Control?Journal of clinical medicine · 2022Article
- Low Diastolic Blood Pressure and Mortality in Older Women. Results From the Women's Health Initiative Long Life Study.American journal of hypertension · 2022Article
- Unravelling the Distinct Effects of Systolic and Diastolic Blood Pressure Using Mendelian Randomisation.Genes · 2022Article
- Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?Journal of geriatric cardiology : JGC · 2022Article
- Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Systolic Blood Pressure Lowering on the Risk of Stroke.Hypertension (Dallas, Tex. : 1979) · 2022Article
- Artificial Intelligence and Cardiovascular Risk Prediction: All That Glitters is not Gold.European cardiology · 2022Review
- Risk factors, prediction model, and prognosis analysis of myocardial injury after acute upper gastrointestinal bleeding.Frontiers in cardiovascular medicine · 2022Article
- The diastolic blood pressure J-curve revisited: An update.American heart journal plus : cardiology research and practice · 2021Review
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18-1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17-1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.