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Isolated diastolic hypertension might not increase cardiovascular risk

Read by Marc Ferrini

Main conclusions

In US adults, the estimated prevalence of Isolated Diastolic Hypertension (IDH) was more common when defined by the 2017 ACC/AHA BP Guidelines compared with the JNC7 Guidelines, but whatever the definition, IDH was not significantly associated with increased risk for cardiovascular (CV) outcomes.

Type of study

Multi-analysis of selected large cross sectional and longitudinal studies. In 9,590 adults from the NHANES, an US cross sectional survey, the estimated prevalence of IDH was 6.5% according to the 2017 ACC/AHA definition, i.e.,systolic BP (SBP) < 130 mm Hg, diastolic BP (DBP) > 80 mmHg, and 1.3 % according to the JNC7 definition, i.e., SBP <140 mm Hg, DBP > 90 mm Hg.  In 8,703 adults from the ARIC, a longitudinal study, there were no significant associations between baseline IDH (by either definition) and either incident atherosclerotic CV disease (HR : 1.06 ; 95%CI: 0.89-1.26), heart failure (HR: 0.91 ; 95%CI : 0.76-1.09) or chronic kidney disease (HR : 0.98; 95%CI: 0.65-1.11). These data were validated in two large cohorts of 36,280 participants representative of US adult population, and in 13,263 participants from the CLUEII (a cohort study of cancer and heart disease): in all cases and whatever its definition, there were no significant associations between IDH and all cause and CV mortality.

Main message for clinical practice

When SBP is well controlled in adults older than 40 years, DBP between 80 and 90 mmHg may have no adverse prognostic significance: should we go on medically treating these patients?


McEvoy J, Daya N, Rahman F et al. Association of Isolated Diastolic Hypertension as Defined by the 2017ACC/AHA Blood Pressure Guideline with Incident Cardiovascular Outcomes.

JAMA 2020;323(4):329-338. doi:10.1001/jama.2019.21402