A US retrospective cohort study concluded that both systolic and diastolic hypertension contribute significantly to cardiovascular risk. The study included 1.3 million adults in a general outpatient population. The burdens of systolic and diastolic hypertension each independently predicted adverse outcomes. In survival models, a continuous burden of systolic hypertension (≥140 mm Hg; hazard ratio per unit increase in z score, 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit increase in z score, 1.06) independently predicted a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years. Similar results were observed with the lower threshold of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. A J-curve relation between diastolic blood pressure and outcomes was seen that was explained at least in part by age and other covariates and by a higher effect of systolic hypertension among persons in the lowest quartile of diastolic blood pressure. Source: https://www.nejm.org/
