Stage 1 and Stage 2 isolated diastolic hypertension were independently associated with a higher incidence of cardiovascular events compared with normal diastolic BP (HR 1.17 and 1.28, respectively).
Cohort (n=1,746,493)
Yes
Does isolated diastolic hypertension based on the 2017 ACC/AHA guidelines increase the risk of cardiovascular events in a general population without systolic hypertension?
Isolated diastolic hypertension, defined by the lower threshold of the 2017 ACC/AHA guidelines (DBP ≥80 mm Hg), is independently associated with an increased risk of subsequent cardiovascular events.
Effect estimate: HR 1.17 (Stage 1), HR 1.28 (Stage 2)
Background The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines lowered the threshold of blood pressure (BP) for hypertension to 130/80 mm Hg. However, the clinical significance of isolated diastolic hypertension (IDH) according to the cutoff value of the 2017 ACC/AHA guidelines was uncertain. Methods and Results We analyzed the claims database of Japan Medical Data Center (a nationwide epidemiological database). We excluded individuals who were aged <20 years, had systolic hypertension, were taking antihypertensive medication, or had prevalent cardiovascular disease, and studied 1 746 493 individuals (mean age, 42.9±10.7 years; 961 097 men 55.0%). The average observational period was 1107±855 days. Stage 1 IDH, defined as diastolic BP 80 to 89 mm Hg, and stage 2 IDH, defined as diastolic BP ≥90 mm Hg, were found in 230 513 (13.2%) and 16 159 (0.9%) individuals, respectively. Compared with individuals with normal diastolic BP, individuals with stage 1 and stage 2 IDH were older and more likely to be men. Prevalence of classic risk factors was higher in patients with IDH. Kaplan-Meier curves showed that stage 1 and stage 2 IDH were associated with a higher incidence of cardiovascular events, defined as myocardial infarction, angina pectoris, and stroke. Multivariable analysis showed that stage 1 (hazard ratio HR, 1.17) and stage 2 (HR, 1.28) IDH were independently associated with a higher incidence of cardiovascular events. Subgroup analyses showed that the association of IDH with cardiovascular events was seen irrespective of age and sex. Conclusions The analysis of a nationwide epidemiological database showed that IDH based on the cutoff value in the 2017 ACC/AHA BP guidelines was associated with an elevated risk of subsequent cardiovascular events.
Kaneko et al. (Wed,) conducted a cohort in Isolated diastolic hypertension (n=1,746,493). Isolated diastolic hypertension (Stage 1 and Stage 2) vs. Normal diastolic BP was evaluated on Cardiovascular events (myocardial infarction, angina pectoris, and stroke) (HR 1.17 (Stage 1), HR 1.28 (Stage 2)). Stage 1 and Stage 2 isolated diastolic hypertension were independently associated with a higher incidence of cardiovascular events compared with normal diastolic BP (HR 1.17 and 1.28, respectively).
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