August 19, 2026Hypertension0 citations
View Full PaperIsolated Diastolic Hypertension and Cardiovascular Disease Risk in Young Adults
Key Result
Isolated diastolic hypertension in young adults was associated with an increased risk of atherosclerotic cardiovascular disease compared with normotension (HR 1.36; 95% CI 1.11-1.68).
Key Points
- To evaluate the risk of atherosclerotic cardiovascular disease and heart failure associated with isolated diastolic hypertension in young adults and characterize hypertension subtype transitions over time.
- Analyzed 23,957 adults aged ≥18 years without baseline cardiovascular disease pooled from 4 US cohorts (mean age 44.5 years, 42.5% aged 18–39 years, 45.1% male).
- Classified hypertension subtypes using blood pressure thresholds of ≥130/80 mm Hg and estimated hazard ratios using Cox proportional hazards models over a median follow-up of 17.2 years.
- In young adults, isolated diastolic hypertension was associated with an increased risk of atherosclerotic cardiovascular disease (HR 1.36, 95% CI 1.11–1.68) and heart failure (HR 1.69, 95% CI 1.24–2.31) compared with normotension.
- Young adults with isolated systolic hypertension had higher risks of atherosclerotic cardiovascular disease (HR 1.54, 95% CI 1.02–2.32) and heart failure (HR 1.92, 95% CI 1.09–3.40), while systolic-diastolic hypertension also showed increased risks (ASCVD HR 1.84, 95% CI 1.46–2.32; HF HR 1.69, 95% CI 1.17–2.43).
- Among young adults with isolated diastolic hypertension, 36.5% progressed to systolic-diastolic hypertension and 29.8% retained isolated diastolic hypertension during follow-up.
Study Design
Type
Cohort (n=23,957)
Multicenter
Yes
Structured PICO
Does isolated diastolic hypertension increase the risk of atherosclerotic cardiovascular disease and heart failure in young adults compared with normotension?
P
Population
23,957 adults aged ≥18 years without cardiovascular disease from 4 US cohorts, followed for a median of 17.2 years.
E
Exposure
Isolated diastolic hypertension (IDH), isolated systolic hypertension, and systolic-diastolic hypertension (defined as BP ≥130/80 mm Hg)
C
Comparator
Normotension
O
Outcome
Atherosclerotic cardiovascular disease and heart failurehard clinical
Isolated diastolic hypertension in young adults is not a benign phenotype but an early marker of increased cardiovascular disease and heart failure risk.
Main Result
Hazard Ratio: 1.36 (95% CI 1.11–1.68)
Abstract
BACKGROUND: Whether isolated diastolic hypertension (IDH) in young adults represents a benign, age-specific phenotype or confers increased cardiovascular disease risk remains uncertain. We assessed the associations between hypertension subtypes, IDH, isolated systolic hypertension, and systolic-diastolic hypertension, with atherosclerotic cardiovascular disease and heart failure. We also characterized longitudinal transitions in hypertension subtypes from young adulthood into later life. METHODS: Adults aged ≥18 years without cardiovascular disease were included from 4 US cohorts. Hypertension subtypes were defined using blood pressure thresholds of ≥130/80 mm Hg. Cox proportional hazards models were used to estimate the associations of hypertension subtypes with atherosclerotic cardiovascular disease and heart failure. RESULTS: Among 23 957 participants (mean age, 44.5 years, 42.5% were young adults aged 18-39 years, 45.1% were male), 2320 atherosclerotic cardiovascular disease and 1243 heart failure events occurred over a median follow-up of 17.2 years. Among young adults, the adjusted hazard ratios (95% CI) for atherosclerotic cardiovascular disease were 1.36 (95% CI, 1.11-1.68) for IDH, 1.54 (95% CI, 1.02-2.32) for isolated systolic hypertension, and 1.84 (95% CI, 1.46-2.32) for systolic-diastolic hypertension, compared with normotension. Corresponding hazard ratios for heart failure were 1.69 (95% CI, 1.24-2.31) for IDH, 1.92 (95% CI, 1.09-3.40) for isolated systolic hypertension, and 1.69 (95% CI, 1.17-2.43) for systolic-diastolic hypertension. Associations were consistent among adults aged ≥40 years. Among young adults with IDH, 29.8% remained with IDH, whereas 36.5% progressed to systolic-diastolic hypertension later in life. CONCLUSIONS: IDH in young adulthood represents an early marker of increased cardiovascular disease risk and a precursor to more adverse hypertension subtypes. These findings underscore the importance of early recognition, ongoing blood pressure monitoring, and guideline-concordant pharmacological treatment, when indicated, among young adults with IDH to reduce long-term cardiovascular disease risk.
Cite This Study
Tang et al. (Mon,) conducted a cohort in Isolated diastolic hypertension (n=23,957). Isolated diastolic hypertension vs. Normotension was evaluated on Atherosclerotic cardiovascular disease (HR 1.36, 95% CI 1.11-1.68). Isolated diastolic hypertension in young adults was associated with an increased risk of atherosclerotic cardiovascular disease compared with normotension (HR 1.36; 95% CI 1.11-1.68).