What causes an increase in diastolic blood pressure (DBP)?

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From the Guidelines

Diastolic blood pressure increases primarily due to factors that affect peripheral vascular resistance or blood vessel elasticity, such as lifestyle factors like high sodium intake, alcohol consumption, obesity, physical inactivity, and smoking, as well as certain medications and underlying medical conditions 1. These factors can lead to increased resistance in the arteries, forcing the heart to work harder during relaxation phases, potentially leading to heart failure and other cardiovascular complications. Some of the key factors that can increase diastolic blood pressure include:

  • Lifestyle factors:
    • High sodium intake: reducing sodium intake to less than 2,300mg daily can help lower diastolic pressure 1
    • Alcohol consumption: limiting alcohol to 1-2 drinks daily can help reduce diastolic pressure
    • Obesity: weight management through regular exercise and a healthy diet can help lower diastolic pressure
    • Physical inactivity: regular exercise, such as 150 minutes weekly of moderate activity, can help reduce diastolic pressure
    • Smoking: quitting smoking can help lower diastolic pressure
  • Medications:
    • NSAIDs: can increase diastolic pressure, especially when used in combination with other medications 1
    • Corticosteroids: can increase diastolic pressure, especially with long-term use
    • Oral contraceptives: can increase diastolic pressure, especially in women with a history of hypertension
    • Decongestants: can increase diastolic pressure, especially when used in excess
  • Underlying medical conditions:
    • Arterial stiffness from aging: can increase diastolic pressure due to decreased elasticity in the arteries
    • Atherosclerosis: can increase diastolic pressure due to the buildup of plaque in the arteries
    • Chronic kidney disease: can increase diastolic pressure due to decreased kidney function
    • Endocrine disorders: such as hypothyroidism, can increase diastolic pressure due to hormonal imbalances Managing diastolic hypertension typically involves lifestyle modifications, as well as medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics if lifestyle changes are insufficient 1. It is essential to address these factors to reduce the risk of cardiovascular complications and improve overall health outcomes. Psychological stress and sleep apnea are also important contributors to elevated diastolic pressure, as they can trigger the sympathetic nervous system, causing blood vessel constriction and increased diastolic pressure 1. By understanding the causes of diastolic hypertension and taking a comprehensive approach to management, individuals can reduce their risk of cardiovascular disease and improve their overall quality of life.

From the Research

Factors Affecting Diastolic Pressure

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can induce an increase in blood pressure, including diastolic pressure, by inhibiting prostaglandin synthesis 2
  • The use of certain antihypertensive drugs, such as diuretics, beta-blockers, and ACE inhibitors, can be affected by NSAIDs, potentially leading to increased diastolic pressure 2
  • In patients already receiving a combination of ACEI/ARB and calcium channel blocker, adding a diuretic may be better than adding a beta-blocker for treating hypertensive patients with prior cerebrovascular accident history 3
  • Increases in diastolic blood pressure are positively associated with cardiac events, but diastolic blood pressure may not be a reliable predictor of cardiovascular events, especially in older adults 4
  • Certain antihypertensive agents, such as ACE inhibitors, may have a positive effect on endothelial function, which can affect diastolic pressure, whereas other agents like calcium antagonists, beta-blockers, and diuretic agents may not have the same effect 5

Mechanisms of Diastolic Pressure Increase

  • Inhibition of prostaglandin synthesis by NSAIDs can lead to increased diastolic pressure 2
  • Sodium retention may not be the single explanation for the increase in diastolic pressure caused by NSAIDs 2
  • Increase in peripheral vascular resistance can elevate diastolic pressure, while arterial stiffening can decrease it, making diastolic pressure a less reliable indicator of cardiovascular risk 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Pulse pressure and cardiovascular risk.

Journal of hypertension. Supplement : official journal of the International Society of Hypertension, 1999

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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