Isolated diastolic hypertension
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Isolated Diastolic Hypertension: Definition and Prevalence
Isolated diastolic hypertension (IDH) is defined as having an elevated diastolic blood pressure (DBP) with a normal systolic blood pressure (SBP). The prevalence of IDH varies depending on the blood pressure thresholds used. For example, using the 2017 ACC/AHA guidelines (DBP ≥80 mm Hg, SBP <130 mm Hg), IDH is more common than when using older or European guidelines with higher thresholds 146. In the United States, the prevalence of IDH has decreased over time but remains notable, especially among men, younger and middle-aged adults, and those with higher body mass index (BMI) . In China, IDH affects a substantial number of people, but awareness and treatment rates are low .
Demographics and Risk Factors for Isolated Diastolic Hypertension
IDH is more frequently observed in younger adults and is rare in older populations 38. Risk factors for IDH include male sex, higher BMI, alcohol consumption, diabetes, and a history of cardiovascular events 4910. IDH is also more common in certain ethnic groups, such as Mexican Americans in the US .
Cardiovascular Risk Associated with Isolated Diastolic Hypertension
The cardiovascular risk associated with IDH is debated. Several studies show that IDH is associated with an increased risk of cardiovascular events, particularly in younger adults 1358+1 MORE. However, in older adults, IDH does not appear to significantly increase cardiovascular risk 38. Some large cohort studies found that the risk of cardiovascular disease (CVD) with IDH depends on the definition used; stricter definitions (higher DBP threshold) are more strongly associated with CVD risk . Other studies suggest that the risk is modest and may not be significant when using lower DBP thresholds 68.
Clinical Management and Treatment Considerations
There is no consensus on the best approach to treating IDH. In younger adults, IDH is associated with long-term cardiovascular risk and may warrant treatment 13810. In contrast, treating IDH in older adults could potentially cause harm, such as increasing the risk of stroke by lowering SBP too much, and should be individualized 38. Awareness and treatment rates for IDH remain low globally, and most treated patients receive only one class of antihypertensive medication 49.
Hemodynamic Profiles and Heterogeneity in Isolated Diastolic Hypertension
Recent research has identified that IDH is not a uniform condition. There are at least two distinct hemodynamic profiles: one characterized by higher cardiac output and heart rate, and another by higher systemic vascular resistance . This heterogeneity suggests that personalized treatment strategies may be more effective than a one-size-fits-all approach 57.
Conclusion
Isolated diastolic hypertension is a common hypertension phenotype, especially in younger adults and those with certain risk factors. Its association with cardiovascular risk is most significant in younger populations, while the risk in older adults is less clear. The condition is heterogeneous, and management should be tailored to individual risk profiles. Awareness and treatment rates are low, highlighting the need for improved recognition and personalized care for those with IDH 1345+5 MORE.
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