Isolated Diastolic Hypertension and Cardiovascular Disease Risk in Young Adults

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.