Does low diastolic blood pressure pose any harm in treating isolated systolic hypertension?
Low diastolic blood pressure has been associated with increased mortality (“J-curved relationship”). This is often the reason that isolated systolic hypertension is not optimally treated. Three possible explanations exist for the J-curved relationship: (1) low diastolic blood pressure could compromise blood flow to target organs, including heart and brain; (2) it could result from increased pulse pressure, reflecting stiff large arteries from advanced vascular disease; and (3) it could be related to underlying chronic conditions. Secondary analyses of data from randomized controlled trials have suggested that increased mortality with low blood pressure was probably related to poor health conditions, rather than treatment effects, because similar relation between blood pressure and mortality was observed between treated and untreated groups, as well as for CV and non-CV mortality.34 In the Systolic Hypertension in Europe trial, achieved diastolic blood pressure as low as 55 mm Hg was no
