Diastolic Blood Pressure Thresholds for Holding Lisinopril

Evidence-Based DBP Thresholds

The European Society of Cardiology recommends a DBP target of <80 mmHg for all hypertensive patients, independent of risk level and comorbidities 1
When DBP is not at target (≥80 mmHg) but systolic BP is controlled (120-129 mmHg), intensifying treatment to achieve DBP of 70-79 mmHg may be considered to reduce cardiovascular risk 1
The American College of Cardiology and American Heart Association recommend a combined BP treatment goal of <130/80 mmHg for adults with confirmed hypertension, with the DBP goal being <80 mmHg 2

DBP consistently falls below 70 mmHg, especially if accompanied by symptoms of hypotension, lisinopril should be held or reduced 3, 4
Symptomatic orthostatic hypotension develops at any DBP level, indicating inadequate cerebral perfusion regardless of the absolute number, and lisinopril should be adjusted 5
DBP is below 75 mmHg in patients with advanced atherosclerotic disease, where the J-curve phenomenon may apply and further lowering could compromise coronary perfusion, and lisinopril should be held or reduced 3, 4

Patients aged ≥85 years should have more lenient BP targets (systolic <140 mmHg), suggesting that aggressive DBP lowering should also be avoided in this population 5, 1
Moderate-to-severely frail patients at any age may require more lenient BP targets (<140/90 mmHg), indicating that lower DBP thresholds for holding medication should be higher in this group 5, 1
Patients with symptomatic orthostatic hypotension should have treatment adjusted regardless of absolute DBP values, as symptoms take precedence over numbers 5, 1