High diastolic blood pressure
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High Diastolic Blood Pressure: Definition and Prevalence
High diastolic blood pressure (DBP) refers to an elevated pressure in the arteries when the heart is resting between beats. Traditionally, a diastolic reading of 90 mmHg or higher is considered high, though recent guidelines also recognize 80 mmHg as a threshold for concern in some populations 610. Globally, the average diastolic blood pressure in adults is around 78–79 mmHg for men and 76–77 mmHg for women, with about 20–24% of adults having raised blood pressure (systolic ≥140 mmHg or diastolic ≥90 mmHg) .
Health Risks Associated with High Diastolic Blood Pressure
Elevated diastolic blood pressure is a strong and independent predictor of adverse cardiovascular events, including heart attack, stroke, heart failure, and cardiac death 347. Both systolic and diastolic hypertension contribute to these risks, and the relationship between blood pressure and cardiovascular outcomes is generally log-linear—meaning risk increases steadily as blood pressure rises above optimal levels 37. Even diastolic blood pressure in the high-normal range (85–89 mmHg) is associated with a higher risk of developing hypertension and cardiovascular disease over time 59.
Special Populations and Distinct Phenotypes
In children, isolated diastolic hypertension (iDH) is less common than isolated systolic hypertension but represents a distinct clinical group. Children with iDH are more likely to be younger, female, leaner, and have higher resting heart rates compared to those with isolated systolic hypertension. This suggests different underlying causes and possibly different long-term risks, though more research is needed .
High Diastolic Blood Pressure and Stroke Risk
In specific conditions like CADASIL (a genetic small vessel disease), high daily diastolic blood pressure is linked to a greater risk of stroke, brain lesions, and cerebral microbleeds. This highlights the importance of monitoring and controlling diastolic blood pressure even in patients without traditional hypertension .
Blood Pressure Targets and Treatment Implications
Current guidelines recommend keeping diastolic blood pressure below 80–90 mmHg, depending on individual risk factors and comorbidities . Both very high and very low diastolic blood pressure can increase the risk of adverse outcomes, especially in high-risk patients with controlled systolic blood pressure. The optimal range for diastolic blood pressure appears to be 70–80 mmHg, with risks rising above and below this range .
Trends and Prevention
While average blood pressure levels have decreased in many high-income countries, the global number of people with high blood pressure has increased due to population growth and aging . Lifestyle changes—such as improved diet, increased physical activity, and smoking cessation—are effective in lowering diastolic blood pressure and reducing the risk of progression to hypertension and cardiovascular disease 69.
Conclusion
High diastolic blood pressure is a significant and independent risk factor for cardiovascular disease, stroke, and other complications. Both adults and children can be affected, and the risks increase steadily as diastolic blood pressure rises above optimal levels. Monitoring, lifestyle changes, and, when necessary, medication are important for managing high diastolic blood pressure and reducing long-term health risks 134678910.
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