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Association between low diastolic blood pressure and subclinical myocardial injury.

Association between low diastolic blood pressure and subclinical myocardial injury.
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Waits GS, O'Neal WT, Sandesara PB, Li Y, Shah AJ, Soliman EZ,


Waits GS, O'Neal WT, Sandesara PB, Li Y, Shah AJ, Soliman EZ, (click to view)

Waits GS, O'Neal WT, Sandesara PB, Li Y, Shah AJ, Soliman EZ,

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Clinical research in cardiology : official journal of the German Cardiac Society 2017 11 21() doi 10.1007/s00392-017-1184-0
Abstract
BACKGROUND
Coronary arteries perfuse cardiac myocytes during diastole. We hypothesized that marked lowering of diastolic blood pressure (DBP) is associated with increased risk of subclinical myocardial injury (SC-MI).

METHODS
This analysis included 6107 participants without history of cardiovascular disease (CVD) from the third National Health and Nutrition Examination Survey. SC-MI was determined by a validated electrocardiogram-based scoring system. Logistic regression was used to examine the cross-sectional association between DBP (< 70, 70-80 mmHg (reference group), and > 80 mmHg; and per each 10 mmHg decrease, separately) with SC-MI across levels of systolic blood pressure (SBP) (< 120, 120-139, or > 140 mmHg).

RESULTS
In a multivariable model, DBP < 70 mmHg was associated with a higher risk of SC-MI [OR (95% CI) 1.40 (1.02, 1.94)] in participants with SBP > 140 mmHg. This association was consistent in subgroups stratified by age, race, diabetes, hypertension, obesity and smoking, but was stronger in women than in men [OR (95% CI) 1.58 (1.06, 2.37) vs. 1.10 (0.62, 1.94), respectively; interaction p value = 0.006]. Also, among participants with SBP > 140 mmHg, every 10 mmHg decrease in DBP was associated with a 12% increased odds of SC-MI [OR (95% CI) 1.12 (1.01, 1.23)]. No significant associations between DBP and SC-MI were observed in those with SBP < 120 mmHg or 120-139 mmHg, or between DBP > 80 mmHg and SC-MI in any of SBP levels.

CONCLUSIONS
Low DBP < 70 mmHg in those with SBP > 140 mmHg carries higher risk of SC-MI, especially in women. Further research is needed to understand the therapeutic implications of these findings.

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