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Paper of the Day- Low diastolic not a problem in older patients

Taking diastolic pressure down to 55mmHg when treating isolated systolic hypertension is probably not a problem for older people, suggests data from the Systolic Hypertension in Europe (Syst-Eur) trial.

But the researchers stress that in those with pre-existing coronary heart disease diastolic pressure should probably not fall lower than 70mmHg.

It has been suggested that low diastolic BP while on antihypertensives is harmful for older patients with systolic hypertension.

Syst-Eur involved randomising 4695 hypertensive patients over the age of 60 into two groups. The active treatment arm involved treatment with nitrendipine - a calcium channel blocker – which could be combined with or replaced by enalapril or hydrocholorothiazide. The other was a placebo arm but patients were switched to active treatment after two years.

Low diastolic BP – down to about 60mmHg - in the active treatment arm was only associated with increased risk of CV events in those who had CHD at the start of the trial.

The authors say the data support the intensification of antihypertensive treatment when systolic BP is not under control in older patients – at least until diastolic BP reaches about 55mmHg.

But for those with established CHD a more 'prudent approach is warranted' and BP should probably not drop below 70mmHg - at which point the relative risk reaches 1.1.

Archives of Internal Medicine 2007;167(17):1884-1891.

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