Should diastolic systolic pulse pressure be used as a treatment target

Should diastolic systolic pulse pressure be used as a treatment target?

Studies for more than 25 years old have consistently shown that systolic BPs correlate more closely to cardiovascular outcomes and mortality than diastolic BPs, at least for older patients. However, diastolic BPs do provide important prognostic information for younger patients (i.e., those younger than 50 years). As patients age, arterial stiffening occurs, which impairs the buffering of the systolic impulse and causes an increase in the reflected wave. With increased arterial stiffening, systolic pressure rises and diastolic pressure falls.

  • • For patients <50 years of age, every 10 mm Hg increase in diastolic BP increases relative cardiovascular risk by 34%.
  • • Patients ≥ 60 years of age, every 10 mm Hg increase in pulse pressure increases cardiovascular risk 24%.
  • • Diastolic and systolic BPs provide equal cardiovascular risk information for patients 50 to 59 years of age.

Patients with CKD, despite being younger, often have increased arterial stiffness and systolic hypertension. Arterial stiffness worsens with higher stages of kidney disease. Therefore among patients with CKD, systolic hypertension should be the major target for treatment.

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