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.
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.
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.