Diastolic Hypotension in a Tertiary Care Hypertension Clinic: Have We Gone Too Far?

Abstract

Background: Treatment-induced diastolic hypotension has been associated with an increased risk of adverse cardiovascular events in post hoc analyses of major blood pressure (BP)-lowering trials. We undertook this retrospective study to assess the prevalence and risk factors for diastolic hypotension among patients referred to a tertiary care hypertension clinic.

Methods: Charts of all active patients were reviewed, and BP at the initial visit was compared with BP at the first visit at which the systolic BP target was achieved or the last visit if the target was not achieved. Diastolic hypotension was defined as diastolic BP < 60 mm Hg.

Results: Four hundred sixty-six patients were identified. The mean baseline BP was 142/77 mm Hg, and the mean number of medications was 2.9. Forty-nine (10.5%) patients had diastolic hypotension at baseline, and a further 68 (16%) acquired it during follow-up. Those with baseline diastolic hypotension had no change in the number of antihypertensive medications being taken on follow-up (mean, 3.6-3.7; P = 0.46), and diastolic BP did not change (53-55 mm Hg; P = 0.07). On adjusted analysis, older age (odds ratio [OR], 1.04; P = 0.0008), diabetes (OR, 2.8; P = 0.002), higher baseline systolic BP (OR, 1.03; P < 0.001), and lower baseline diastolic BP (OR, 0.003; P < 0.001) were predictors of diastolic hypotension at follow-up.

Conclusions: Treating systolic hypertension resulted in diastolic hypotension in 27% of patients followed at a tertiary care hypertension clinic. Its presence does not usually result in the reduction of antihypertensive therapy. Older patients, patients with diabetes, and patients with isolated systolic hypertension appear to be more susceptible to the development of diastolic hypotension during therapy.