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Objective: The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) Guideline remains controversial. Described cardiovascular effects are inconsistent due to BP variability, confounding by systolic BP, and effect modification by age. We examined whether long-term diastolic burden independently predicts the first major adverse cardiovascular event (MACE) in participants with sustained untreated normal systolic BP. Design and method: The Mass General Brigham Biobank is a volunteer cohort study of New England adults recruited between 2010 and 2021 across eight healthcare sites. A total of 18,181 participants aged 18 to 64 years and without prior cardiovascular disease, antihypertensives prescription, or high systolic BP were studied. Cumulative diastolic burden was determined as the area under curve for diastolic BP (DBP) 80 mmHg or higher over a 5-year period prior to enrollment. MACE was defined as a composite of first incident ischemic heart disease, stroke, heart failure, or all-cause death. Hazard ratio (HR) between cumulative diastolic burden and MACE was estimated using Cox proportional hazards regression. Results: Of the 18,181 participants, mean SD age at enrollment was 47.6 14.3 years, 13,574 74.7% were female, and 2853 (15.7%) MACE occurred over a median IQR follow-up of 3.5 1.9-5.3 years. Each SD increase in cumulative DBP was associated with HR (95% CI) of 1.07 (1.03-1.11), adjusting for age, sex, race, body mass index, systolic BP, lipids, renal function, diabetes, smoking, statin, and antihypertensives initiation during follow-up. In addition to traditional risk factors, cumulative DBP improved the discrimination C index (95% CI) from 0.73 (0.72-0.74) to 0.74 (0.73-0.75) (Likelihood ratio test P=0.019), whereas inclusion of enrollment DBP did not improve prognosis. Conclusions: Among individuals with normal systolic BP, cumulative DBP may augment risk stratification beyond a single DBP measure and other traditional risk factors.
Cho et al. (Wed,) studied this question.