Background: Hypertension subtypes—isolated systolic (ISH), isolated diastolic (IDH), and combined systolic-diastolic (SDH)—have distinct prognostic implications, yet differential mortality risks remain underexplored. This study evaluates mortality trends across hypertension subtypes in a nationally representative cohort. Methods: We analyzed 47,582 adults (NHANES 1999–2020), categorizing participants by hypertension subtype (ISH, IDH, SDH) using thresholds of ≥140/90 mmHg (general population) and ≥130/80 mmHg (CAD subgroup). Mortality data (1999–2018) were linked via the National Death Index. Weighted logistic regression and Kaplan-Meier survival analyses were adjusted for sociodemographics and comorbidities. Results: ISH patients were older (mean age 65.9) with higher Medicare use; IDH patients were younger (44.3), predominantly male, and often uninsured. Age-adjusted mortality was highest in ISH (aOR 1.32, 95% CI 1.24–1.41 at ≥140/90 mmHg; aOR 1.20 at ≥130/80 mmHg), followed by SDH (aOR 1.60 and 1.31, respectively). IDH showed no significant risk at ≥130/80 mmHg but increased mortality at DBP ≥90 mmHg (aOR 1.45, 95% CI 1.12–1.89). Survival curves (Figures 1, 2) revealed ISH had the poorest outcomes (log-rank *p*<0.001), while IDH demonstrated favorable survival in unadjusted models—a paradox reversed after age adjustment. Conclusions: ISH is a robust predictor of mortality, independent of age, and underscores the need for aggressive systolic control. IDH, which is prevalent in younger adults, warrants age-specific management, with treatment reserved for severe cases (DBP ≥90 mmHg). These findings advocate for subtype-tailored hypertension guidelines to optimize outcomes
Abdalla et al. (Mon,) studied this question.