Too-Low Blood Pressure Can Also Bring Danger – Yahoo! News

May 27, 2009

THURSDAY, May 7 (HealthDay News) — While too-high blood pressure
is a clear hazard for most people, too-low pressure can apparently be a
threat in some cases as well.

"It stands to reason that there has to be a J-shaped curve," Messerli
said. "If your blood pressure were zero, you would be dead."

He acknowledged that the people in the study were a bit out of the
ordinary, with already-diagnosed coronary artery disease. The study was
aimed at determining the effect of treatment with different amounts of a
cholesterol-lowering statin drug, with blood pressure measured as a matter
of routine.

When the results were in, the lowest rate of deaths and major coronary
problems such as heart disease was seen not in the participants with the
lowest blood pressure but in those slightly to the right on the curve,
with a reading of 139.9 for systolic pressure (the reading when the heart
contracts) and 79.2 for diastolic pressure.

Though Messerli stressed that this was "a unique population, with
coronary artery disease, where the coronary arteries are compromised," he
noted that "there has to be a point where lowering blood pressure is
counterproductive."

That point can be seen on the curve of systolic pressure in this group,
he said. "When you go from 120 to 130, even from 110 to 130, there is very
little difference," Messerli said. "When it goes below 110, then all of a
sudden it becomes very obvious."

The effect is more pronounced for diastolic pressure readings. "If you
go to 70 or below, say to 60, there is a fourfold higher risk in the
primary outcomes," he said.

A too-low reading, he noted, could mean that the brain is not getting
enough blood. "Obviously, if there is a lack of blood, there can be
danger similar to that when there is too much blood," Messerli said.

The finding in this particular group certainly doesn't mean that most
people should worry about blood pressure being too low, he said. "By and
large, within reason, lower is better," Messerli said.

But that might not be true in special cases, he said. "You can have a
funny situation where one organ in the body is demanding more blood than
is good for the rest of the body," Messerli said. "What is OK for the
kidney and OK for the brain may not be OK for the heart."

Controlling high blood pressure remains a major concern for physicians,
Messerli said. "There are a lot of patients who are untreated and
uncontrolled," he said. "We need to do a better job."

Dr. Alan H. Gradman, professor of medicine at Temple University, said
that the study should be treated with caution because the number of people
with very low blood pressure was small, but he said that "it does suggest
that there may well be a J curve in people with coronary artery
disease."

Though many other studies have not shown a J curve, "which is why the
idea that you can't go too low is out there," the new study results might
mean a slight revision of that rule in some cases, Gradman said.

"If you treat people with coronary artery disease for hypertension, you
don't want to go too low, to diastolic pressure below about 70," he said.
"That's the take-home message here."

More information

The U.S. National Heart, Lung and Blood Institute has more on high blood pressure.

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