The Diastolic Blood Pressure J-Curve in Hypertension Management: Links and Risk for Cardiovascular Disease

Strategising, which is an effective workplace intervention to curb cardiovascular disease (CVD), requires understanding of the CVD risk related to a specific working population. The Framingham Risk Score (FRS) is widely used in predicting the ten-year CVD risk of various working populations. This study aimed to use FRS to determine the ten-year CVD risk amongst workers in a tertiary healthcare setting and its associated factors. A cross-sectional study was conducted on workers who participated in the special health check programme at the staff clinic of a tertiary healthcare institution in Kuala Lumpur, Malaysia. A set of data sheets was used to retrieve the workers’ sociodemographic and CVD risk information. The prevalence of high, moderate and low ten-year CVD risk was 12.8%, 20.0% and 67.2%, respectively. Workers in the high-risk group were older [mean age: 54.81 (standard deviation, 5.72) years], male (44%), smokers (72.7%) and having hyperglycaemia (46.7%) and hypertriglyceridemia [median triglycerides: 1.75 (interquartile range, 1.45) mmol/L]. Diastolic blood pressure (aOR 1.07, 95% CI: 1.01,1.14), hyperglycaemia (aOR 8.80, 95% CI: 1.92,40.36) and hypertriglyceridemia (aOR 4.45, 95% CI: 1.78,11.09) were significantly associated with high ten-year CVD risk. Diastolic blood pressure (aOR 1.08, 95% CI: 1.03,1.13) and hypertriglyceridemia (aOR 2.51, 95% CI: 1.12-5.61) were significantly associated with moderate ten-year CVD risk. The prevalence of high and moderate ten-year CVD risk was relatively high. Amongst the workers in the high-risk group, they were older, male, smokers and with high fasting blood sugar and triglyceride. Understanding the ten-year CVD risk and its associated factors could be used to plan periodic workplace health assessment and monitor to prevent CVD.

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A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease

Clinical Hypertension ◽

10.1186/s40885-021-00185-z ◽

2022 ◽

Vol 28 (1) ◽

Author(s):

Linda P. Bolin ◽

Amelia D. Saul ◽

Lauren L. Bethune Scroggs ◽

Carolyn Horne

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Pilot Study ◽

Family History ◽

Diastolic Blood Pressure ◽

Biofeedback Training ◽

Paced Breathing ◽

History Of

Abstract Background Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. Methods Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. Results The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. Conclusions The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability.

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Is There a J Curve Distribution for Diastolic Blood Pressure?

Clinical and Experimental Hypertension Part A Theory and Practice ◽

10.3109/10641969209036177 ◽

1992 ◽

Vol 14 (1-2) ◽

pp. 139-149 ◽

Cited By ~ 4

Author(s):

Christopher G. Isles ◽

David J. Hole

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

J Curve

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Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽

10.1161/hyp.70.suppl_1.031 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

John W McEvoy ◽

Faisal Rahman ◽

Mahmoud Al Rifai ◽

Michael Blaha ◽

Khurram Nasir ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Coronary Artery Calcium ◽

J Curve ◽

Increased Risk ◽

All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

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Clinical disparity of oxidative stress with blood pressure

Journal of Biomedical Sciences ◽

10.3126/jbs.v6i3.26821 ◽

2019 ◽

pp. 3

Author(s):

Elsa Mathew ◽

J.K. Mukkadan

Keyword(s):

Oxidative Stress ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Total Cholesterol ◽

Diastolic Blood Pressure ◽

Pearson Correlation ◽

World Health ◽

Oxidative Stress Marker ◽

Major Public Health Problem ◽

Hypertensive Patients

Background: Cardiovascular disease is one of the leading causes of mortality and morbidity in India and worldwide. Hypertension is a major public health problem because of its high frequency and concomitant risk of cardiovascular disease, kidney disease, and stroke. World Health Organization named it a Silent killer as hypertension is asymptomatic during its clinical course. Experimental evidence supports a role for oxidative stress in vascular injury and hypertension. This study was undertaken, to compare the serum levels of malondialdehyde (MDA) and super-oxide dismutase (SOD) among normotensive, prehypertensive and hypertensive subjects. Materials and methods: In this cross-sectional study, 34 normotensives, 44 prehypertensive and 45 hypertensive subjects were included. The participants were subjected to selection protocol consisting of physical examination and biochemical analysis. All subjects underwent blood pressure measurement, total cholesterol, and oxidative stress marker estimation, especially SOD and MDA. The comparison of parameters between the group was carried out using One Way ANOVA. The correlation between the parameter was analyzed by Karl Pearson Correlation Coefficient using SPSS 20.0. Result : The MDA (nmol/ml) in normotensive, prehypertensive and hypertensive patients was 2.55±0.072, 3.43±0.44 and 4.01±0.37 respectively. SOD (U/ml) level in normotensive, prehypertensive and hypertensive patients was 13.47±1.96, 11.57±0.81, and 8.52±1.78 respectively. Systolic and diastolic blood pressure had a negative correlation with SOD. MDA levels show a positive correlation with systolic blood pressure and diastolic blood pressure. Total cholesterol had no significant with SOD and MDA. Conclusion: The present study showed a strong association of oxidative stress with systolic and diastolic blood pressure.

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The J-curve between Diastolic Blood Pressure and Risk of All-cause and Cardiovascular Death

Korean Circulation Journal ◽

10.4070/kcj.2017.0036 ◽

2018 ◽

Vol 48 (1) ◽

pp. 36 ◽

Cited By ~ 9

Author(s):

Heejin Kimm ◽

Yejin Mok ◽

Sun Ju Lee ◽

Sunmi Lee ◽

Joung Hwan Back ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cardiovascular Death ◽

J Curve

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430 Relation of blood pressure to coronary artery calcium and mortality

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.243 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I J Cho ◽

J H Lee ◽

S Y Choi ◽

E J Chun ◽

S H Park ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Artery ◽

Diastolic Blood Pressure ◽

Coronary Artery Calcium ◽

Multicenter Observational Study ◽

J Curve ◽

Increased Risk ◽

All Cause Mortality ◽

Study Population ◽

Artery Disease

Abstract Background Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC). Methods The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (> 300 and ≤ 300), and all-cause mortality was assessed. Results The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS > 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS > 300, whereas DBP < 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg. Conclusion Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.

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