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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target?
Steven Tringali, Jian Huang, Department of Medicine, University of California San Francisco-Fresno Medical Education Program, Fresno, CA 93701, United States
Jian Huang, Department of Medicine, Veterans Administration Central California Health Care System, Fresno, CA 93703, United States
Author contributions: All the authors contributed to the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian Huang, MD, Department of Medicine, Veterans Administration Central California Health Care System, 2615 E Clinton Ave, Fresno, CA 93703, United States. jian.huang@va.gov
Telephone: +1-559-2256100 Fax: +1-559-2416484
Received: August 30, 2016
Peer-review started: September 1, 2016
First decision: October 26, 2016
Revised: November 20, 2016
Accepted: December 16, 2016
Article in press: December 18, 2016
Published online: February 23, 2017
Processing time: 171 Days and 4.3 Hours
Peer-review started: September 1, 2016
First decision: October 26, 2016
Revised: November 20, 2016
Accepted: December 16, 2016
Article in press: December 18, 2016
Published online: February 23, 2017
Processing time: 171 Days and 4.3 Hours
Core Tip
Core tip: Reduction of diastolic blood pressure to less than 60-80 mmHg appears to lead to adverse cardiovascular events in high risk patient populations. Currently, only two major society guidelines on hypertension include a minimum threshold for diastolic blood pressure. Available studies demonstrating adverse events at lower diastolic blood pressure vary in their cutoff values and patient populations. Randomized controlled trials comparing outcomes across different diastolic blood pressure targets are limited. Hypertension guideline goals should be based on an individual’s age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.