From the Guidelines
Low diastolic blood pressure (below 60 mmHg) can result from several causes, including aging, dehydration, heart valve problems, medications, endocrine disorders, and severe infections, and treatment should focus on addressing the underlying cause while considering the potential risks of overtreatment, as suggested by the SHEP investigators 1.
Causes of Low Diastolic Blood Pressure
- Aging: Arteries naturally stiffen with age, causing systolic pressure to rise while diastolic pressure falls.
- Dehydration: Reduced blood volume can lead to decreased diastolic pressure.
- Heart valve problems: Conditions like aortic regurgitation can contribute to low diastolic readings.
- Medications: Alpha-blockers, beta-blockers, calcium channel blockers, diuretics, and ACE inhibitors can lower diastolic pressure.
- Endocrine disorders: Hypothyroidism, adrenal insufficiency, and severe infections leading to sepsis can reduce diastolic pressure.
- Pregnancy: Diastolic pressure may drop, especially in the first and second trimesters.
- Heart conditions: Bradycardia, heart valve problems, and heart failure may contribute to low diastolic readings.
Importance of Diagnosing the Underlying Cause
Diagnosing the underlying cause of low diastolic blood pressure is crucial, as treatment should be tailored to address the root cause, and symptoms like dizziness, fatigue, or fainting should be evaluated to determine the best course of action, as emphasized in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
Considerations for Treatment
- Asymptomatic individuals with isolated low diastolic pressure may not require treatment.
- Those experiencing symptoms should seek medical evaluation to identify and address the root cause.
- The potential risks of overtreatment, as suggested by the SHEP investigators, should be considered when managing low diastolic blood pressure, particularly in elderly patients, as noted in the 2007 guidelines for the management of arterial hypertension 1.
- The 2019 ACC/AHA/HRS versus ESC guidelines for the diagnosis and management of syncope also highlight the importance of considering the underlying cause and symptoms when evaluating and managing patients with low diastolic blood pressure 1.
From the Research
Low Diastolic Pressure Reasons
- Low diastolic pressure can be caused by various factors, including dehydration, blood loss, and certain medical conditions 2.
- Medications such as beta-blockers, ACE inhibitors, and diuretics can also contribute to low diastolic pressure 3, 4, 5, 6.
- In some cases, low diastolic pressure can be a sign of an underlying health issue, such as heart failure or cardiac arrhythmias 2, 5.
Related Factors
- Hypertension is a major risk factor for heart failure, and diastolic heart failure is often associated with hypertension 2.
- Beta-blockers, ACE inhibitors, and other medications can help manage hypertension and reduce the risk of heart failure 3, 4, 5, 6.
- Lifestyle factors, such as diet and exercise, can also play a role in managing blood pressure and reducing the risk of low diastolic pressure 3, 6.
Treatment Options
- Treatment for low diastolic pressure typically depends on the underlying cause and may involve medications, lifestyle changes, or other interventions 3, 4, 5, 6.
- In some cases, increasing fluid intake or using medications to constrict blood vessels may be necessary to raise diastolic pressure 3.
- It is essential to work with a healthcare provider to determine the best course of treatment for low diastolic pressure, as it can be a sign of an underlying health issue 2, 5.