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Old 01-06-2008, 07:34 PM   #1
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B/P meds & diastolic below 65

In Prevention magazine 2/08, a study of 22,000 pts with
clogged arteries ( who doesn't have these?) found that decreasing the diastolic (2nd number) below 70 doubled the risk of heart attack and or stroke. The reason given is that these patients need the extra pressure to propel the blood through the clogged blood vessels. On the other hand, the pts who have had surgery to clear the blood vessels can have a lower diastolic the article says.

Every since my systolic b/p has been lowered, I've been concerned about my low diastolic (usually in the 50's). I figure it probably is higher when I'm up & about but during sleep it may cause lack of oxygen to my vital organs such as brain, heart, kidneys.

One of the first b/p guidelines (in the 90's I think) that I read said not to let the diastolic go below 70 so I wondered why it suddenly can be lower now in 2008.

Dr. Mcgowan in her book says that 70 is the bottom line for pts with heart problems (I think it was heart failure).

In my new book " Clinical Hypertension, " Kaplan mentions the diastolic problem several times. He gives both sides of the agrument for & against reducing the diastolic but finally says that the Dr. should weigh the risks of a low diastolic against the risks of having a higher systolic.

The exception is pts with renal & heart problems who would benefit from lower diastolic to 75.

In another chapter, he discusses a study of 2,351 pts (elderly) who were on b/p meds who had a increased risk for strokes if their diastolic b/p's were below 65.

As most of us with very high b/p's know, there are few b/p meds who reduce mainly systolic. One is Norvasc which I had terrible side effects with. The 2nd one is a diuretic which really helped decrease my systolic without further lowering my diastolic although the pkg insert says it lowers both.

Losing weight & decreasing unnessary stress seems the best way for me to decrease my systolic. Then I can get rid of at least 100mg of Lebetalol I hope.

If anyone has any other info on this subject please post it as we all have questions about this subject. Thanks. Fam

 
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Old 01-07-2008, 07:22 AM   #2
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Re: B/P meds & diastolic below 65

Hi!

I have been wondering about this issue too because I read somewhere that high pulse pressure--defined as the difference between systolic and diastolic measurements--is a cause for concern. Does anyone have any information on the implications of high pulse pressure?

I'm interested in this because while on my other medicine (I've switched from an ACE inhibitor to an ARB) my diastolic went down pretty fast while my systolic remained a bit elevated. My ARB is working but not as effectively as my ACE in lowering both measurements.

Thanks for posting this.

M.Rain

 
Old 01-07-2008, 09:59 PM   #3
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Re: B/P meds & diastolic below 65

Hi,

Quote:
Every since my systolic b/p has been lowered, I've been concerned about my low diastolic (usually in the 50's). I figure it probably is higher when I'm up & about but during sleep it may cause lack of oxygen to my vital organs such as brain, heart, kidneys.
One of the first b/p guidelines (in the 90's I think) that I read said not to let the diastolic go below 70 so I wondered why it suddenly can be lower now in 2008.
You might be interested in reading Syst-Eur Analysis, which was done with patients with isolated systolic hypertension in Belgium.

The results of this recent study suggest that diastolic blood pressure as low as 50mmHg is NOT associated with increased risks of adverse events.
However, diastolic blood pressure of less than 70mmHg IS associated with higher incidence of adverse events in isolated systolic hypertension.

Interesting, isn't it?
It would seem that normal or low diastolic pressure is what differentiates people with essential hypertension from people with isolated systolic hypertension. People with ISH have normal or low diastolic pressure. The normal or low diastolic with elevated systolic pressure in ISH is caused by age-related arterial stiffness and non-compliance. As we age, the systolic increases while the diastolic pressure decreases. There should be an intense antihypertensive treatment of people with isolated systolic hypertension until the diastolic reaches 55mmHg. In people with coronary heart disease large reductions of diastolic BP (below 70mmHg) should be avoided. The potential risk arising from low diastolic pressure does not outweigh the positive effects of reduced systolic pressure.

The best medication for reaching the desired effect (according to what I read) are the CCBs and ACEIs. The nitrates are best for relaxing the conduit arteries.
In people with ISH, cuff systolic BP measurement is pretty close to intra-arterial brachial and intra-aortic pressure. However, cuff diastolic measurement usually overestimates intra-arterial brachial artery pressure.

Quote:
Dr. Mcgowan in her book says that 70 is the bottom line for pts with heart problems (I think it was heart failure).
Everyone seems to agree that 70 should be the minimal diastolic in people with CHF. This was shown by studies. I forget which ones. I think the SHEP study touched on that.

Quote:
As most of us with very high b/p's know, there are few b/p meds who reduce mainly systolic. One is Norvasc which I had terrible side effects with. The 2nd one is a diuretic which really helped decrease my systolic without further lowering my diastolic although the pkg insert says it lowers both.
I read that the CCBs, ACEs and nitrates were the best for that.
Very interesting post, Fam! It would be great to have more information. This is something that concerns most of us.

flowergirl

 
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