Diastolic hypertension
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Diastolic Hypertension: Insights and Cardiovascular Risks
Understanding Diastolic Hypertension
Diastolic Hypertension Definition and Prevalence
Diastolic hypertension (DH) is characterized by elevated diastolic blood pressure (DBP) while systolic blood pressure (SBP) remains within normal limits. According to the 2018 European Society of Cardiology (ESC) and 2019 National Institute for Health and Care Excellence (NICE) guidelines, isolated diastolic hypertension (IDH) is defined as SBP <140 mmHg and DBP ≥90 mmHg . The prevalence of IDH has increased significantly, especially under the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, which have lowered the threshold for hypertension diagnosis.
Cardiovascular Risks Associated with Diastolic Hypertension
Increased Risk of Cardiovascular Events
Multiple studies have shown that IDH is significantly associated with an increased risk of cardiovascular (CV) events. A meta-analysis involving 489,814 participants found that IDH is linked to a higher risk of composite cardiovascular events, cardiovascular mortality, and all strokes, including hemorrhagic stroke (HS). Another systematic review confirmed these findings, highlighting that IDH increases the risk of CV events and CV mortality but not all-cause mortality.
Age and Regional Variations in Risk
The risk associated with IDH varies by age and geographical region. Younger individuals (mean age ≤55 years) and those from Asia are at a higher risk of composite cardiovascular events compared to older individuals and those from Europe and North America . This suggests that demographic factors play a crucial role in the impact of IDH on cardiovascular health.
Comparative Risks of Systolic and Diastolic Hypertension
While systolic hypertension (SH) has a more pronounced effect on cardiovascular outcomes, diastolic hypertension independently contributes to adverse events. A study involving 1.3 million adults demonstrated that both systolic and diastolic hypertension independently predict myocardial infarction, ischemic stroke, and hemorrhagic stroke. The study also noted a J-curve relationship, where very low diastolic blood pressure could also be harmful, particularly in older adults.
Mechanisms and Pathophysiology
Diastolic Dysfunction and Hypertension
Diastolic dysfunction, characterized by impaired left ventricular filling, is a common consequence of hypertension and a predictor of heart failure. Hypertension contributes to diastolic dysfunction through mechanisms such as hemodynamic overload and myocardial ischemia . Blood pressure lowering treatments can improve diastolic function, although it remains unclear if this translates to better cardiovascular outcomes.
Genetic Factors
Genetic predispositions also play a role in blood pressure regulation and the development of hypertension. Genome-wide association studies have identified several genetic loci associated with variations in blood pressure, which could potentially serve as targets for therapeutic interventions.
Conclusion
Diastolic hypertension is a significant risk factor for cardiovascular events, particularly in younger adults and certain populations. While systolic hypertension has a more substantial impact on cardiovascular outcomes, the independent contribution of diastolic hypertension cannot be overlooked. Effective management of diastolic blood pressure is crucial in mitigating the associated cardiovascular risks. Further research is needed to explore the long-term benefits of treating diastolic hypertension and to understand the underlying genetic factors contributing to its development.
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