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Cardiovascular Risks Associated With Diastolic Blood Pressure and Isolated Diastolic Hypertension

  • Blood Pressure Monitoring and Management (G Ogedegbe and JA Staessen, Section Editors)
  • Published:
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Abstract

Hypertension is a major reversible risk factor for cardiovascular complications. According to recent guidelines, hypertension can be subdivided into isolated diastolic, isolated systolic, and systolic and diastolic mixed hypertension using proposed thresholds of various blood pressure components. In the present article, we reviewed the association of cardiovascular outcomes with diastolic blood pressure versus systolic blood pressure and with isolated diastolic hypertension versus systolic and mixed hypertension in observational prospective cohort studies and large-scale individual data-based meta-analysis. Blood pressure was measured either in the clinic or at home or under ambulatory conditions for 24 h in cohort studies. To illustrate the treatment effect of diastolic blood pressure lowering, we also reviewed randomized placebo-controlled outcome trials in diastolic hypertension. Conclusions: The risks conferred by diastolic and systolic blood pressure, irrespective of the methods of blood pressure measurement, are age-dependent. Diastolic blood pressure and isolated diastolic hypertension drive coronary risk in younger subjects, whereas systolic blood pressure is the predominant risk indicator in older people. Reversibility of the risk by diastolic BP lowering treatment in randomized trials confirms that diastolic hypertension is a risk factor that must be treated.

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Sources of Funding

The authors were financially supported by grants from the National Natural Science Foundation of China (30871360, 30871081, 81170245, and 81270373), the Ministry of Science and Technology (a grant for China-European Union collaborations [1012]), the Ministry of Education (NCET-09-0544), and National TCM Clinical Research Bases (JDZX2012115), Beijing China, the Shanghai Commissions of Science and Technology (11QH1402000) and Education (the “Dawn” project 08SG20), the Shanghai Bureau of Health (XBR2011004), and Shanghai Jiaotong University School of Medicine (a grant of Distinguished Young Investigators to Yan Li).

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Conflict of Interest

Dr. Wang reports receiving lecture and consulting fees from the companies of Boehringer-Ingelheim, MSD, Novartis, Omron, Pfizer, Servier, and Takeda.

Yan Li, Shuai Wang, Fang-Fei Wei, and Yi-Bang Cheng declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Centre for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yan Li, Fang-Fei Wei, Shuai Wang, Yi-Bang Cheng & Ji-Guang Wang

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  1. Yan Li
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  2. Fang-Fei Wei
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  3. Shuai Wang
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  4. Yi-Bang Cheng
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  5. Ji-Guang Wang
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Correspondence to Yan Li.

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This article is part of the Topical Collection on Blood Pressure Monitoring and Management

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Li, Y., Wei, FF., Wang, S. et al. Cardiovascular Risks Associated With Diastolic Blood Pressure and Isolated Diastolic Hypertension. Curr Hypertens Rep 16, 489 (2014). https://doi.org/10.1007/s11906-014-0489-x

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  • DOI: https://doi.org/10.1007/s11906-014-0489-x

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