Korean Circ J.  2018 Jan;48(1):36-47. 10.4070/kcj.2017.0036.

The J-curve between Diastolic Blood Pressure and Risk of All-cause and Cardiovascular Death

• Kimm H
• Mok Y
• Lee SJ
• Lee S
• Back JH
• Jee SH

• KMID: 2405044
• DOI: http://doi.org/10.4070/kcj.2017.0036

Abstract

BACKGROUND AND OBJECTIVES
The J-curve phenomenon between diastolic blood pressure (DBP) and mortality has been reported repeatedly in treated patients. However, the baseline risk of low DBP has not been fully explored. This study was to examine the relationship between DBP and risk of mortality from all-cause, atherosclerotic vascular diseases (ASCVD), and ischemic heart disease (IHD) using a prospective cohort of general population.
METHODS
We analyzed 1,234,435 participants of the Korean Cancer Prevention Study cohort (789,255 men, 30-95 years of age) who had a medical evaluation from 1992 to 1995 using Cox proportional hazards models.
RESULTS
A total of 22.5 million person-years were followed up (mean age 46.6 years, deaths 193,903 cases). The hazard ratios of mortality from all-cause and ASCVD, among those with DBP < 60 mmHg compared to 70-79 mmHg were 1.23 (95% confidence interval [CI], 1.16-1.30) and 1.37 (95% CI, 1.20-1.57), respectively, after adjustment for multivariable including systolic blood pressure. Increased risks of all-cause death in the lowest DBP category group were maintained in men or women, 30-59 or ≥60 years of age, smoker or non-smoker and diabetes mellitus (DM) or non-DM subgroups. The risk in DBP 60-69 mmHg groups increased in several subgroups. However, the risk for ASCVD death in 30-59 years and DM group, and risk for IHD death in most subgroups except for elderly (≥60 years) decreased.
CONCLUSION
A J-curve relationship between low DBP and all-cause death was found consistently. The baseline risk in the general population may be considered for risk assessment, particularly in case of interventions that lower DBP below 60 mmHg.

Keyword

Blood pressure; Diastolic blood pressure; Hypertension; Mortality; Myocardial ischemia

MeSH Terms

Aged
Blood Pressure*
Cohort Studies
Diabetes Mellitus
Female
Humans
Hypertension
Male
Mortality
Myocardial Ischemia
Proportional Hazards Models
Prospective Studies
Risk Assessment
Vascular Diseases

Figure

• 

  Figure 1 HRs from multivariable adjusted model of total, ASCVD, and IHD death by DBP categories stratified by sex and age. Multivariable adjusted HRs for total, ASCVD, and IHD mortality by 8 categories of DBP stratified by sex and age. The referent category for DBP was 70–79 mmHg. Each dot indicates HRs, and vertical lines over the dots mean 95% CIs. Age was divided into 2 groups: 30–59 years and 60 years or older (range: 60–95 years). (A, C, E) Blue line shows results in men, and orange line in women. (B, D, F) Blue line means ≥60 years age group, and orange line means 30–59 years age group. The y-axis scale was different for the 3 outcomes (0–2.0 or 0–2.5). ASCVD = atherosclerotic cardiovascular diseases; CI = confidence interval; DBP = diastolic blood pressure; HR = hazard ratio; IHD = ischemic heart disease.

• 

  Figure 2 HRs from multivariable adjusted model of total, ASCVD, and IHD deaths by DBP categories stratified by diabetes and tobacco smoking. Multivariable adjusted HRs for total, ASCVD, and IHD mortality by 8 categories of DBP stratified by diabetes and tobacco smoking status. The referent category for DBP was 70–79 mmHg. Each dot indicates HRs, and vertical lines over the dots mean 95% CIs. (A, C, E) Blue line shows results in non-DM participants, and orange line in DM participants. (B, D, F) Blue line means ex- or non-smokers, and orange line means current smokers. The y-axis scale was different for each result (0–1.60 to 0–3.50). ASCVD = atherosclerotic cardiovascular diseases; CI = confidence interval; DBP = diastolic blood pressure; DM = diabetes mellitus; HR = hazard ratio; IHD = ischemic heart disease.

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