Two digits represent the blood pressure. The higher number is the systolic pressure or the pressure the heart puts on blood arteries as it beats. The force generated while the heart is at rest, known as diastolic pressure, is weak in many respects. Physician and patient attention is mainly focused on systolic BP. Diastolic blood pressure is often disregarded in favor of systolic blood pressure. During systole, the bulk of your arteries supply your organs. Your coronary arteries, however, are unique in that they surround the aortic valve and only get blood when that valve shuts during diastole.
In 2011, Guichard and Ali Ahmed, M.D., then a professor of medicine in the UAB Division of Gerontology, Geriatrics and Palliative Care and currently the associate chief of staff for Health and Aging at the Veterans Affairs Medical Center in Washington, D.C., published an influential paper in Hypertension that helped bring diastolic pressure to more people’s attention.
The phrase “isolated diastolic hypotension,” developed in that study, describes a condition with normal systolic blood pressure (above 100 mm Hg). Still, the diastolic blood pressure is low (less than 60 mm Hg). According to the researchers, older persons who meet those criteria are more likely to get heart failure that just started.
Guichard said, “High blood pressure is a problem, but low blood pressure is also a problem.” This insight influenced the panelists nominated to the Eighth Joint National Committee (JNC 8) in 2014 to soften target blood pressure recommendations for those over 60. Read Guichard’s perspective on the new recommendations and “ideal blood pressure” in this blog post.
“Years ago and until recently, doctors were treating blood pressure so aggressively that many patients couldn’t even stand up without getting dizzy,” said Guichard. “We want people to know they don’t have to let their blood pressure fall to zero, to the point where they can’t play with their grandchildren, play golf, or take a simple stroll around the block because it’s that low. It’s critical to increase knowledge in this area, particularly among seniors.
Ahmed and Guichard are still delving further into the factors behind low diastolic pressure. Guichard reports that many fresh papers are still waiting. He sat down with The Mix to discuss the risks of low blood pressure.
The majority of individuals work to reduce their blood pressure. What do you consider “too low,” and why is it a concern?
A diastolic blood pressure of between 90 and 60 in older adults is ideal. People start feeling uneasy once you start dropping below 60. Many older people with low diastolic blood pressure experience fatigue or dizziness and often fall. Naturally, none of it is good news for older adults with fragile bones and other problems.
During the diastolic period, your coronary arteries get nourishment. Low coronary artery pressure is a sign of low diastolic pressure, which implies your heart will be depleted of blood and oxygen. This is known as ischemia, and this form of persistent, low-level ischemia has the potential to weaken the heart over time and result in heart failure.
What may result in a person’s diastolic blood pressure being low?
The biggest one is medications. Certain medications, notably a family of drugs known as alpha-blockers or centrally-acting anti-hypertensive agents, are responsible for decreasing your diastolic blood pressure more than your systolic.
Age is still another factor. Your arteries develop stiffer as you age, increasing your systolic pressure and decreasing your diastolic pressure.
Finding methods to keep your vessels elastic, or, if they’ve lost it, ways to regain it, is one prospective treatment for slowing down the aging process.
Cutting down on salt consumption is the best course of action since it is strongly related to how elastic your blood vessels are. Your blood vessels will become less flexible as you consume more salt. Most individuals consume too much salt. Although salt consumption is hotly contested in medicine, most experts agree that daily salt intakes of more than 4 grams and less than 1.5 grams are excessive. This varies depending on a person’s age and underlying health issues, but this range is a decent generalization. Although this is also hotly contest, some research suggests that 3.6 grams of salt is the recommend daily amount for healthy individuals.
The UAB hypertension team, led by Drs. Suzanne Oparil and David Calhoun have extensively covered the fundamental research demonstrating the molecular effects of salt on blood arteries. Your blood arteries are coat on the inside by a thin layer of endothelial cells. These cells respond quickly to the addition of salt in an experimental context. They stiffen up, lose their flexibility, and become less reactive, which you see in a clinical setting.
Additionally, and this is intriguing, the vessels stiffen very quickly when you consume salt while eating.
What can individuals do to increase their diastolic pressure if it is too low other than changing their medications?
Dietary and exercise modifications to one’s lifestyle may have instant results. Much more quickly than the mirror can reflect, your interior changes. By improving your diet, engaging in regular exercise, managing your weight, and quitting smoking, you’re becoming much healthier.
Everyone believes they must continue doing this for six to twelve months before seeing any results. That is untrue. The body moves around a lot. You may reap the rewards of a lifestyle modification within a few weeks. You may see a difference in dietary changes in salt consumption in a day or two.
What should patients and their physicians be on the lookout for if they have low diastolic pressure?
The most critical thing is regular monitoring, which may include seeing a patient more often in the clinic and keeping a close eye out for heart failure or cardiovascular disease symptoms if they are not on drugs that we may change.