Alan P Jacobsen1, Mahmoud Al Rifai2, Kelly Arps3, Seamus P Whelton1, Matthew J Budoff4, Khurram Nasir5, Michael J Blaha1, Bruce M Psaty6, Roger S Blumenthal1, Wendy S Post1, John W McEvoy1,7. 1. Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 2. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. 3. Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 4. Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA. 5. Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA. 6. Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington and Kaiser Permanente Health Research Institute, Seattle, WA, USA. 7. National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway School of Medicine, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland.
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 <130 mmHg and diastolic blood pressure ≥80 mmHg) was associated with the above outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA). In a random-effects meta-analysis of the association between IDH and CVD events, we combined the MESA results with those from seven other previously published cohort studies. Among the 5104 MESA participants studied, 7.5% had IDH by the 2017 ACC/AHA criteria. There was no association between IDH and CAC [e.g. adjusted prevalence odds ratio for CAC >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. Published on behalf of the European Society of Cardiology. All rights reserved.
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 <130 mmHg and diastolic blood pressure ≥80 mmHg) was associated with the above outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA). In a random-effects meta-analysis of the association between IDH and CVD events, we combined the MESA results with those from seven other previously published cohort studies. Among the 5104 MESA participants studied, 7.5% had IDH by the 2017 ACC/AHA criteria. There was no association between IDH and CAC [e.g. adjusted prevalence odds ratio for CAC >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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Stanley S Franklin; Jose R Pio; Nathan D Wong; Martin G Larson; Eric P Leip; Ramachandran S Vasan; Daniel Levy Journal: Circulation Date: 2005-02-21 Impact factor: 29.690
Authors: Hokyou Lee; Yuichiro Yano; So Mi Jemma Cho; Jong Heon Park; Sungha Park; Donald M Lloyd-Jones; Hyeon Chang Kim Journal: Circulation Date: 2020-06-01 Impact factor: 29.690
Authors: Hokyou Lee; Yuichiro Yano; So Mi Jemma Cho; Sungha Park; Donald M Lloyd-Jones; Hyeon Chang Kim Journal: Hypertension Date: 2020-10-19 Impact factor: 10.190
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: J Am Coll Cardiol Date: 2017-11-13 Impact factor: 24.094
Authors: Hanyu Ni; Colin Wu; Ronald Prineas; Steven Shea; Kiang Liu; Richard Kronmal; Diane Bild Journal: Am J Hypertens Date: 2006-04 Impact factor: 2.689
Authors: John W McEvoy; Natalie Daya; Faisal Rahman; Ron C Hoogeveen; Roger S Blumenthal; Amil M Shah; Christie M Ballantyne; Josef Coresh; Elizabeth Selvin Journal: JAMA Date: 2020-01-28 Impact factor: 56.272
Authors: John W McEvoy; Wen-Yi Yang; Lutgarde Thijs; Zhen-Yu Zhang; Jesus D Melgarejo; José Boggia; Tine W Hansen; Kei Asayama; Takayoshi Ohkubo; Eamon Dolan; Katarzyna Stolarz-Skrzypek; Sofia Malyutina; Edoardo Casiglia; Lars Lind; Jan Filipovský; Gladys E Maestre; Yan Li; Ji-Guang Wang; Yutaka Imai; Kalina Kawecka-Jaszcz; Edgardo Sandoya; Krzysztof Narkiewicz; Eoin O'Brien; Thomas Vanassche; Jan A Staessen Journal: Hypertension Date: 2021-10-04 Impact factor: 10.190