Vol.:(0123456789) 1 3 Clinical Research in Cardiology https://doi.org/10.1007/s00392-017-1184-0 ORIGINAL PAPER Association between low diastolic blood pressure and subclinical myocardial injury George S. Waits 1  · Wesley T. O’Neal 2  · Pratik B. Sandesara 2  · Yabing Li 3  · Amit J. Shah 2,4  · Elsayed Z. Soliman 3,5 Received: 17 August 2017 / Accepted: 17 November 2017 © Springer-Verlag GmbH Germany, part of Springer Nature 2017 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 stratifed 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 signifcant 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 fndings. Keywords Diastolic blood pressure · Subclinical myocardial injury Introduction The common goal in the management of hypertension is to reduce the risk for cardiovascular disease (CVD) and its complications, but diferences arise with respect to the approach. Diastolic blood pressure (DBP) goals were tradi- tionally emphasized, but more recently, management focus has shifted to systolic blood pressure (SBP). Furthermore, exact threshold pressures at which to initiate and target phar- macologic therapy have been debated. For example, the Sys- tolic Blood Pressure Intervention Trial (SPRINT) showed a reduction in cardiovascular outcomes with an intensive goal SBP of ≤ 120 mmHg as compared with ≤ 140 mmHg in individual without diabetes [1]. In contrast, the Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial (ACCORD-BP) did not show a diference in outcomes when comparing the same blood pressure treatment goal categories in those with diabetes [2]. Additionally, the Heart * Elsayed Z. Soliman esoliman@wakehealth.edu 1 Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA 2 Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA 3 Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA 4 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA 5 Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA