Diastolic hypertension may not increase CV risk despite higher prevalence with updated guideline
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The 2017 American College of Cardiology/American Heart Association BP guideline identified more patients with isolated diastolic hypertension compared with the 2003 Joint National Committee guideline, according to a study published in JAMA.
Despite this, incident diastolic hypertension was not linked to an increased risk for CV outcomes, according to the study.
“Once systolic BP is normal either naturally or with treatment, it appears to matter little what the diastolic BP number is,” John W. McEvoy, MBBCh, MEd, MHS, professor of preventive cardiology at the National University of Ireland in Galway, medical and research director of the National Institute for Prevention and Cardiovascular Health in Galway, a consultant cardiologist at University College Hospital Galway and a Cardiology Today Next Gen Innovator, told Healio. “This finding is even more true now than before, with new U.S. guidelines defining hypertension as a systolic BP as low as 130 mm Hg or more.”
Researchers performed cross-sectional analyses of 9,590 patients (mean age, 50 years; 52% women) from the National Health and Nutrition Examination Survey from 2013 to 2016 and longitudinal analyses of 8,703 patients (mean age, 56 years; 57% women) from the ARIC study.
Results were validated in two external cohorts consisting of data from 1988-1994 NHANES, 1999-2014 NHANES and the Give Us a Clue to Cancer and Heart Disease II (CLUE II) study.
Incident diastolic hypertension was defined as a systolic BP less than 130 mm Hg and a diastolic BP of at least 80 mm Hg according to the 2017 ACC/AHA BP guideline. The Joint National Committee (JNC7) guideline defined incident diastolic hypertension as a systolic BP less than 140 mm Hg and a diastolic BP of at least 90 mm Hg.
In NHANES, the estimated prevalence of incident diastolic hypertension was higher using the ACC/AHA guideline vs. the JNC7 guideline (6.5% vs. 1.3%; absolute difference = 5.2 percentage points; 95% CI, 4.7-5.7). Of the patients who were newly diagnosed with incident diastolic hypertension, 0.6% were estimated to meet the guideline threshold for antihypertensive therapy.
Compared with patients from the ARIC study who were normotensive, patients who had incident diastolic hypertension according to the ACC/AHA guideline did not have an increased risk for incident atherosclerotic CVD during a median follow-up of 25.2 years (HR = 1.06; 95% CI, 0.89-1.26). These patients also did not have an increased risk for HF (HR = 0.91; 95% CI, 0.76-1.09) or chronic kidney disease (HR = 0.98; 95% CI, 0.65-1.11).
Null results were also observed regarding CV mortality in the external cohorts including NHANES (HR = 1.17; 95% CI, 0.87-1.56) and CLUE II (HR = 1.02; 95% CI, 0.92-1.14).
“Our data suggest that isolated diastolic hypertension is not associated with adverse clinical outcomes,” McEvoy said in an interview. “Therefore, these adults may not warrant the label of having ‘hypertension’ and more particularly may not need treatment. The most important thing appears to be focusing on ensuring that systolic BP is controlled (ie, below 130 mm Hg). – by Darlene Dobkowski
For more information:
John W. McEvoy, MBBCh, MEd, MHS, can be reached at National University of Ireland, Galway Campus, National Institute for Prevention and Cardiovascular Health, Moyola Lane, Galway H91 FF68, Ireland; email: johnwilliam.mcevoy@nuigalway.ie.
Disclosures: McEvoy reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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