A cohort study and meta-analysis of isolated diastolic hypertension: searching for a threshold to guide treatment

Abstract Aims  Whether isolated diastolic hypertension (IDH), as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, is associated with cardiovascular disease (CVD) has been disputed. We aimed to further study the associations of IDH with (i) subclini...

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Published in:European heart journal 2021-06, Vol.42 (21), p.2119-2129
Main Authors: Jacobsen, Alan P, Al Rifai, Mahmoud, Arps, Kelly, Whelton, Seamus P, Budoff, Matthew J, Nasir, Khurram, Blaha, Michael J, Psaty, Bruce M, Blumenthal, Roger S, Post, Wendy S, McEvoy, John W
Format: Article
Language:English
Subjects:
Aged
Blood Pressure
Cardiovascular Diseases
Clinical Research
Cohort Studies
Humans
Hypertension - epidemiology
Middle Aged
Risk Factors
United States
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Summary:Abstract Aims  Whether isolated diastolic hypertension (IDH), as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, is associated with cardiovascular disease (CVD) has been disputed. We aimed to further study the associations of IDH with (i) subclinical CVD in the form of coronary artery calcium (CAC), (ii) incident systolic hypertension, and (iii) CVD events. Methods and results  We used multivariable-adjusted logistic and Cox regression to test whether IDH by 2017 ACC/AHA criteria (i.e. systolic blood pressure 0 of 0.88 (95% CI 0.66, 1.17)]. Similarly, while IDH was associated with incident systolic hypertension, there was no statistically significant associations with incident CVD [hazard ratio 1.19 (95% CI 0.77, 1.84)] or death [hazard ratio 0.94 (95% CI 0.65, 1.36)] over 13 years in MESA. In a stratified meta-analysis of eight cohort studies (10 037 843 participants), the 2017 IDH definition was also not consistently associated with CVD and the relative magnitude of any potential association was noted to be numerically small [e.g. depending on inclusion criteria applied in the stratification, the adjusted hazard ratios ranged from 1.04 (95% CI 0.98, 1.10) to 1.09 (95% 1.03, 1.15)]. Conclusion  The lack of consistent excess in CAC or CVD suggests that emphasis on healthy lifestyle rather than drug therapy is sufficient among the millions of middle-aged or older adults who now meet the 2017 ACC/AHA criteria for IDH, though they require follow-up for incident systolic hypertension. These findings may not extrapolate to adults younger than 40 years, motivating further study in this age group. Graphical Abstract In the Multi-Ethnic Study of Atherosclerosis (MESA), isolated diastolic hypertension (IDH) by the 2014 ACC/AHA definition is associated with future development of systolic hypertension but is not significantly associated with coronary artery calcification (CAC) or cardiovascular disease (CVD) events. These MESA resul
ISSN:0195-668X
1522-9645
1522-9645
DOI:10.1093/eurheartj/ehab111