Biomarkers · Cardiac & Hemodynamics
Diastolic Blood Pressure (DBP)
Both low and high values go with higher risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 4% lower risk of death. Risk rises at both ends: not comparable
DBP and risk of death
NHANES, our fit with 95% CIPublished curve
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.
Risk of death per SD (NHANES)0.96×95% CI 0.94–0.98 · 49,318 adults, 7,264 deaths
Published risk of death2.16×DBP >=110 mmHg vs 70-79 mmHg (reference) (95% CI 1.09–4.31) · Nationally representative sample of community-dwelling older adults (60-97 y) in Singapore, BP measured 2009, mortality to end-2015
DBP across cohorts
0.911.1HR per SD (95% CI)
NHANES · United States, 20–8449,318 people · 7,264 deaths0.96 0.94–0.98
CRELES · Costa Rica, 60+2,602 people · 502 deaths0.95 0.85–1.07
HRS · United States, 50+24,148 people · 8,515 deaths1.00 0.98–1.03
CHARLS · China, 50+10,447 people · 1,715 deaths1.10 1.01–1.19
DBP by age and sex
Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.
The percentiles as a table
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 54.7 | 64.7 | 70.7 | 77.3 | 90.3 | 1,449 | NHANES 2017-2018 |
| All | 40-59 | 60.0 | 70.0 | 76.0 | 83.3 | 94.0 | 1,576 | NHANES 2017-2018 |
| All | 60+ | 49.5 | 63.3 | 70.7 | 77.3 | 88.7 | 1,923 | NHANES 2017-2018 |
| All | all | 54.7 | 65.3 | 72.7 | 79.3 | 92.0 | 4,948 | NHANES 2017-2018 |
| Men | 20-39 | 55.4 | 66.0 | 73.3 | 80.0 | 93.3 | 704 | NHANES 2017-2018 |
| Men | 40-59 | 62.7 | 72.0 | 77.3 | 86.0 | 95.3 | 744 | NHANES 2017-2018 |
| Men | 60+ | 52.7 | 64.7 | 71.5 | 78.7 | 90.7 | 980 | NHANES 2017-2018 |
| Men | all | 56.0 | 67.3 | 74.7 | 81.3 | 94.0 | 2,428 | NHANES 2017-2018 |
| Women | 20-39 | 54.0 | 62.7 | 68.7 | 74.7 | 84.0 | 745 | NHANES 2017-2018 |
| Women | 40-59 | 57.7 | 68.0 | 75.3 | 81.3 | 92.7 | 832 | NHANES 2017-2018 |
| Women | 60+ | 48.0 | 62.0 | 68.7 | 76.7 | 86.7 | 943 | NHANES 2017-2018 |
| Women | all | 53.3 | 64.0 | 70.7 | 77.3 | 88.7 | 2,520 | NHANES 2017-2018 |
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in DBP, study by study
7 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| behavioral | Device-guided slow breathing (10 min daily for 8 weeks) in uncontrolled hypertension | Clinic BP change -7.5/-4.0 mm Hg with guided breathing vs -2.9/-1.5 mm Hg control (significance reported for systolic only) | RCT | Grossman E, et al. J Hum Hypertens. 2001;15:263-269. |
| diet | Dietary Approaches to Stop Hypertension eating pattern (fruit, vegetables, low-fat dairy, reduced saturated fat) followed daily; adults with and without hypertension | Lowers DBP by 2.5 mmHg (95% CI -3.5 to -1.5) and SBP by 3.2 mmHg vs a control diet | meta-analysis | Filippou CD, et al. Adv Nutr. 2020. Dietary Approaches to Stop Hypertension… |
| diet | Daily cocoa extract or >=70% cocoa dark chocolate for at least 4 weeks in adults with or without comorbidities | Lowers DBP by 1.58 mmHg (95% CI -2.54 to -0.62) and SBP by 2.52 mmHg with >=4 weeks of cocoa | meta-analysis | Arisi TOP, et al. Nutrients. 2024. Effects of Cocoa Consumption on… |
| exercise | Weight reduction via energy restriction, increased physical activity, or both | DBP -3.57 mm Hg for net weight loss of -5.1 kg; -5.12 mm Hg in populations losing >5 kg | meta-analysis | Neter JE, et al. Hypertension. 2003;42:878-884. |
| exercise | Supervised or home-based endurance exercise training for at least 4 weeks in healthy adults | Endurance training lowers resting DBP by 2.5 mmHg (95% CI -3.2 to -1.7); -5.2 mmHg in hypertensive subgroups | meta-analysis | Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic… |
| exercise | Isometric resistance training (e.g. handgrip or wall squat holds) in adults with hypertension versus sedentary or sham control | Lowers office DBP by 3.17 mmHg (95% CI -5.29 to -1.04) and SBP by 7.47 mmHg in people with hypertension | meta-analysis | Baffour-Awuah B, Pearson MJ, Dieberg G, et al. Curr Hypertens Rep. 2023. |
| pharmacologic | Calcium channel blockers (Amlodipine 5-10 mg) / ACE inhibitors | Each drug class (incl. CCB, ACEi) lowered DBP 5.5 mm Hg at standard dose (placebo-adjusted); three half-dose drugs est. 11 mm Hg | meta-analysis | Law MR, et al. Value of low dose combination treatment with blood pressure… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| pharmacologic | Excessive over-titration of multi-agent vasodilators causing DBP < 55 mmHg | J-shaped risk with on-treatment DBP (nadir 119/84 mm Hg); low DBP increased death and MI in 22 576 hypertensive CAD patients | cohort | Messerli FH, et al. Dogma disputed: can aggressively lowering blood pressure in… |
What else moves this marker
They describe those study groups, not an individual, and an association is not a cause.
Diseases and conditions
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↑ Periodontitis · patients with periodontitis vs periodontally healthy | +2.03 mmHg (95% CI 1.25 to 2.81) | periodontitis vs non-periodontitis · Adults in 40 studies pooled from 81 selected studies | meta analysis · PMID 31549149 |
Genetic predisposition
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↓ SLC39A8 rs13107325 · per minor allele, UK Biobank participants of European ancestry | -0.531 mmHg (beta per allele; units not reported) per allele | per copy of the rs13107325 minor allele · 276,436 UK Biobank participants of Caucasian genetic ancestry, no genetic kinship | cross sectional · PMID 41097109 |
Environmental and occupational exposures
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↑ Acute alcohol, high dose (>30 g), 13-24 hours after · single high dose vs placebo, >=13 h after consumption | +2.4 mmHg (95% CI 0.2 to 4.5) | >30 g alcohol vs placebo, >=13 hours after consumption · 154 mostly healthy adults in 4 randomised trials | meta analysis · PMID 32609894 |
| ↓ Acute alcohol, medium dose (14-28 g), within 6 hours · single dose vs placebo, 0-6 h after consumption | -4 mmHg (95% CI -6 to -2) | 14-28 g alcohol vs placebo within 6 hours · 149 mostly healthy adults (mean age 33 y, predominantly male) in 10 randomised trials | meta analysis · PMID 32609894 |
| ↑ Acute e-cigarette use · acute vaping vs non-use | +7.676 mmHg | acute e-cigarette exposure vs non-use · Human studies of acute e-cigarette exposure (12 studies meta-analysed of 63 reviewed) | meta analysis · PMID 40010935 |
| ↑ Maternal smoking during pregnancy (moderate-heavy, continuous) · newborn girls, moderate-high continuous maternal smoking vs none | +2.9 mmHg (95% CI 0.72 to 5.02) | moderate-high continuous maternal smoking vs no smoking, female newborns · 6985 mother-infant dyads from Northern Plains (USA) and Cape Town (South Africa); measurements 12-96 h after delivery | prospective cohort · PMID 35440768 |
Sources
- Risk curve: Lian 2022 (PMID 34814767): all-cause HR 2.16 (1.09-4.31) DBP >=110 mmHg vs 70-79 mmHg (reference); DBP <50 mmHg: 2.41 (1.28-4.54). Scaled to US values (NHANES).
- Lian et al. Association of Systolic and Diastolic Blood Pressure With All-Cause Mortality Among Community-Dwelling Older Adults: A Prospective Observational Study. Journal of aging and health. 2022;34:674-683.
- NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Diastolic Blood Pressure (DBP) against another biomarker.
Related markers: Abdominal Aortic Calcification (AAC) · Ankle-Brachial Index (ABI) · Cardiac (Valvular/Annular) Calcification · Carotid Intima-Media Thickness (CIMT) · Carotid-Femoral Pulse Wave Velocity (PWV) · Copeptin · Coronary Artery Calcium Score (Agatston) · Corrected QT Interval (QTc)