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

  • Author(s): Haring, Bernhard;
  • McGinn, Aileen P;
  • Kamensky, Victor;
  • Allison, Matthew;
  • Stefanick, Marcia L;
  • Schnatz, Peter F;
  • Kuller, Lewis H;
  • Berger, Jeffrey S;
  • Johnson, Karen C;
  • Saquib, Nazmus;
  • Garcia, Lorena;
  • Richey, Phyllis A;
  • Manson, JoAnn E;
  • Alderman, Michael;
  • Wassertheil-Smoller, Sylvia
  • et al.

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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). 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. 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. 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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