Causes of high diastolic blood pressure
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Causes of High Diastolic Blood Pressure
Hypertension and Diastolic Dysfunction
High diastolic blood pressure (DBP) is a significant contributor to diastolic dysfunction (DD), which is a major precursor to heart failure. Hypertension-induced DD is often associated with left ventricular hypertrophy (LVH), characterized by an increase in nonmyocyte elements and myocardial fibrosis. These changes in heart structure and function are key indicators of cardiovascular risk, independent of left ventricular mass and ambulatory blood pressure.
Global Trends in Diastolic Blood Pressure
From 1975 to 2015, global trends in diastolic blood pressure have shown significant regional variations. High-income countries have seen a substantial decrease in mean DBP, while low-income and middle-income countries, particularly in South Asia and sub-Saharan Africa, have experienced an increase. This shift is attributed to population growth, aging, and varying prevalence rates of hypertension across different regions.
Genetic and Lifestyle Factors
Both genetic predisposition and lifestyle factors play crucial roles in determining high blood pressure levels. A study involving 277,005 individuals found that a healthy lifestyle, including maintaining a healthy body mass index, diet, and physical activity, can significantly mitigate the effects of genetic risk for high blood pressure. This suggests that lifestyle modifications are essential in managing and reducing the risk of elevated DBP and associated cardiovascular events, regardless of genetic predisposition.
Mitochondrial DNA and Blood Pressure
Research on the impact of mitochondrial DNA (mtDNA) variants on blood pressure has shown that mtDNA variations do not significantly influence DBP. Studies involving over 4,200 individuals from Finnish cohorts found no substantial associations between common or rare mtDNA single-nucleotide polymorphisms (mtSNPs) and blood pressure traits, indicating that nuclear DNA may play a more critical role in blood pressure regulation.
Systolic vs. Diastolic Blood Pressure
While both systolic and diastolic blood pressures are important, evidence suggests that systolic blood pressure (SBP) is a stronger predictor of cardiovascular and renal disease risk. However, elevated DBP remains a critical factor in hypertension-related complications. Prospective studies and randomized controlled trials have shown that reductions in SBP are associated with significant decreases in coronary heart disease, stroke, and overall cardiovascular mortality, underscoring the importance of managing both SBP and DBP.
Genetic Linkage Studies
Genetic studies, such as those conducted on participants from the Framingham Heart Study, have identified specific loci on chromosomes 17 and 18 that are linked to long-term mean systolic and diastolic blood pressure. These findings highlight the heritability of blood pressure traits and the potential for identifying specific genes that influence DBP, which could lead to improved evaluation and treatment strategies for hypertension.
Conclusion
High diastolic blood pressure is influenced by a combination of hypertension, genetic predisposition, and lifestyle factors. While global trends show regional variations, lifestyle modifications remain a key strategy in managing elevated DBP. Genetic studies continue to uncover the complex interactions that contribute to high blood pressure, offering hope for more targeted and effective treatments in the future.
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