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Review
. 2021 Oct 16;23(12):177.
doi: 10.1007/s11886-021-01609-w.

Is Isolated Diastolic Hypertension an Important Phenotype?

Cesar A Romero  1 , Aldo H Tabares  2 , Marcelo Orias  3
Affiliations
Review

Is Isolated Diastolic Hypertension an Important Phenotype?

Cesar A Romero et al. Curr Cardiol Rep. .

Abstract

Purpose of review: Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions.

Recent findings: Recent guidelines lowering blood pressure cutoff levels have increased IDH prevalence and likely decreased associated cardiovascular risk. Long-term cardiovascular risk and pharmacological intervention in IDH are controversial. Narrow pulse pressure and other physiological and epidemiological characteristics are shared with a systodiastolic hypertension (SDH) subgroup. We propose that IDH be incorporated into a broader category, predominantly diastolic hypertension (PDH), defined by pulse pressure ≤ 45 mmHg and includes IDH and SDH with a narrow pulse pressure. IDH-PDH is associated with cardiovascular risk in the long term, especially in young patients. Standardization of the IDH definition and population may contribute to future research to understand genetics, pathophysiology, and eventually therapy in this important subgroup of hypertensive patients.

Keywords: Hypertension in young patients; Hypertension prognosis; Isolated diastolic hypertension; Narrow pulse pressure; Predominantly diastolic hypertension.

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Conflict of interest statement

Conflict of Interest Dr. Orias reports personal fees from AstraZeneca and Glaxo, outside the submitted work. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Natural history of the blood pressure phenotype. IDH and some SDH with narrow pulse pressure are classified as a PDH. Those patients may evolve to SDH. These patients can remain as an IDH or evolve to ISH. Recent guidelines lowered cutoff levels and IDH may be associated with low cardiovascular risk; however, young patients have long-term increased cardiovascular risk. ISH corresponds to elderly patients. Modified from [9]. IDH, isolated diastolic hypertension; SDH, systodiastolic hypertension; ISH, isolated systolic hypertension; PDH, predominantly diastolic hypertension
See this image and copyright information in PMC

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