Guidelines for Managing Low Diastolic Blood Pressure

ESC‑Defined Thresholds

The 2024 European Society of Cardiology (ESC) guideline states that in pregnant women receiving treatment for hypertension, diastolic blood pressure should not be reduced below 80 mmHg; this is the only explicit lower limit for diastolic pressure cited in current major guidelines. 1

Observational data summarized in the ESC guideline indicate that a diastolic blood pressure of 60–69 mmHg is linked to a modest but statistically significant rise in all‑cause mortality (hazard ratio ≈ 1.11), marking the beginning of a transitional risk zone. 1

The ESC recommends promptly assessing patients for signs of hypoperfusion—such as dizziness, syncope, chest discomfort, or altered mental status—when a diastolic pressure of 48 mmHg is encountered. 2
A comprehensive medication review should be performed, with particular attention to antihypertensive agents, vasodilators, and diuretics, to identify drugs that may be contributing to excessive diastolic lowering. 3
Clinicians should investigate secondary causes of low diastolic pressure, including sepsis, dehydration, cardiac dysfunction, and autonomic dysregulation. 1

For patients already on antihypertensive therapy, the ESC advises that medication regimens be adjusted (e.g., dose reduction or discontinuation of certain agents) to raise diastolic pressure toward safer levels. 2