IS IT REASONABLE TO DECREASE THE DEFINITION OF DIASTOLIC HYPERTENSION FROM 90 MMHG TO 80 MMHG IN THE ELDERLY? THE NORTHERN SHANGHAI STUDY

Abstract

Objective: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines decreased the definition of diastolic hypertension to 80 mmHg from 90 mmHg. However, this action may not be appropriate in the elderly, considering the limited value of increased DBP in predicting future cardiovascular risk and the worse prognosis associated with significant lower DBP in the elderly. Design and method: A total of 1178 participants with SBP<130 mmHg derived from the Northern Shanghai Study, a prospective study focusing on the cardiovascular risk of the community-dwelling elderly Chinese in the northern Shanghai, China, were included. Study participants were divided into Group 1 (DBP<80 mmHg) and Group 2 (80<DBP<90 mmHg) according to DBP level. Survival analysis and Cox proportional hazard regression were used to study the future cardiovascular risk of the two groups. Results: After 5.8 years of follow-up, a total of 172 events were observed. Survival analysis showed no significant difference in the rates of the primary endpoints between two groups (14.9%vs14.0%, P = 0.80). In multiple COX proportional hazard regression, after adjusted for covariates, participants in Group 2 showed similar future cardiovascular risk (Hazard Ratio 1.05, 95% Confidence Interval 0.75-1.48, P = 0.78), as compared with Group 1. Conclusions: No increased cardiovascular risk observed in the elderly with SBP<130 mmHg and DBP between 80-90 mmHg, compared with those with DBP<80 mmHg. Therefore, it is maybe unreasonable to downregulate the definition of the diastolic hypertension in the elderly.