From the Guidelines
If your diastolic blood pressure is above 80 mmHg, you should aim to lower it to less than 80 mmHg to reduce the risk of micro- and macrovascular complications, as recommended by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases 1. To achieve this goal, consider the following lifestyle modifications:
- Reduce sodium intake to less than 2,300 mg daily
- Increase physical activity to at least 150 minutes of moderate exercise weekly
- Maintain a healthy weight
- Limit alcohol consumption
- Adopt the DASH diet rich in fruits, vegetables, and whole grains Regular home blood pressure monitoring using a validated device is also recommended, with readings taken at the same time daily. If lifestyle changes don't improve your numbers within 3-6 months or if your diastolic pressure exceeds 90 mmHg consistently, consult a healthcare provider who may prescribe medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics, as suggested by the 2019 ESC guidelines 1 and the ACC/AHA hypertension guidelines 1. It's essential to note that elevated diastolic pressure increases your risk of cardiovascular disease by creating excessive pressure against arterial walls during the heart's resting phase, potentially leading to heart disease, stroke, and kidney damage over time. The 2020 study on blood pressure and the new ACC/AHA hypertension guidelines 1 also emphasizes the importance of accurate blood pressure measurement and the use of absolute cardiovascular risk to determine high-risk status. However, the most recent and highest quality study, the 2019 ESC guidelines 1, prioritizes the diastolic BP target of <80 mmHg, but not <70 mmHg, to reduce the risk of micro- and macrovascular complications.
From the FDA Drug Label
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit The FDA drug label does not answer the question.
From the Research
Diastolic Blood Pressure Above 80
- A diastolic blood pressure above 80 mmHg is considered elevated and may require lifestyle modifications and/or medication to reduce the risk of cardiovascular events and mortality 2.
- The 2017 American College of Cardiology/American Heart Association hypertension guidelines recommend treatment of noninstitutionalized ambulatory community-dwelling persons aged 65 years and older with an average systolic blood pressure of 130 mm Hg or higher or a diastolic blood pressure of 80 mm Hg or higher with lifestyle measures plus antihypertensive drug to lower the blood pressure to less than 130/80 mm Hg 2.
- Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years, and a blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 3.
- Lifestyle modifications, such as the Dietary Approaches to Stop Hypertension (DASH) diet, sodium restriction, regular exercise, and moderate weight loss, are associated with improvements in blood pressure and can help reduce diastolic blood pressure 3, 4.
Lifestyle Modifications
- The DASH diet, which is enriched in fruits, vegetables, and low-fat dairy products and low in total and saturated fat, has been shown to be effective in lowering blood pressure in patients with high-normal or Stage 1 hypertension 4.
- Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a recommended lifestyle modification for patients with mildly or moderately elevated blood pressure and blood cholesterol 5.
- Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with elevated blood pressure and blood cholesterol 5.
Medication
- Combination therapy with a renin-angiotensin-aldosterone system (RAAS) inhibitor and a calcium channel blocker (CCB) or a diuretic may be effective in reducing blood pressure and cardiovascular events in patients with hypertension 6.
- The choice of medication and combination therapy should be individualized based on patient characteristics, such as age, comorbidities, and cardiovascular risk factors 3, 2, 6.