The clinical significance of isolated diastolic hypertension

被引:17
作者
Chrysant, Steven G. [1 ]
机构
[1] Univ Oklahoma, Hlth Sci Ctr, Dept Cardiol, Oklahoma City, OK 73142 USA
关键词
Isolated diastolic hypertension; cardiovascular events; stroke; age; treatment; HIGH BLOOD-PRESSURE; SYSTOLIC HYPERTENSION; AMERICAN-COLLEGE; ASSOCIATION; PREDICTORS; PREVENTION; MORTALITY; SUBTYPES; ACC/AHA; GUIDELINE;
D O I
10.1080/00325481.2020.1788294
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The prevalence of isolated diastolic hypertension (IDH) has been increased in hypertensive subjects with the new 2017 ACC/AHA blood pressure treatment guidelines to 6.5% from 1.3% by the JNC-7 guidelines. However, its clinical significance as a cause of adverse cardiovascular (CV) events especially in older subjects has been debated by several investigators, who have demonstrated no adverse CV effects of untreated IDH, but not by others. It is also more common in the young subjects who are at low CV risk and quite rare in the older subjects, who are at increased CV risk. Treatment of IDH in the older subjects could increase the CV complications due to a J-curve effect and, in addition, could increase the incidence of stroke from further lowering the normal systolic blood pressure (SBP). Very low SBP and DBP cannot be sustained by the cerebral blood flow autoregulation and could lead to cerebral ischemia. In order to get a better perspective of the current status of the treatment of IDH, a review of the English language literature of the available studies was conducted and 12 papers with pertinent information were retrieved. The analysis of results from these studies suggests that IDH is associated with adverse CV events in younger persons and it should be treated. In contrast, the prevalence of IDH is low in older subjects and is not associated with adverse CV events in the majority of cases. Thus, its further lowering should be avoided to prevent further decrease in normal SBP and prevent the onset of adverse CV events. However, the decision to treat IDH in older subjects should be individualized.
引用
收藏
页码:624 / 628
页数:5
相关论文
共 44 条
  • [1] [Anonymous], 1991, JAMA, V265, P3255
  • [2] EFFECTS OF TREATMENT ON MORBIDITY IN HYPERTENSION - RESULTS IN PATIENTS WITH DIASTOLIC BLOOD PRESSURES AVERAGING 115 THROUGH 129 MM HG
    不详
    [J]. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1967, 202 (11): : 1028 - &
  • [3] [Anonymous], 1970, JAMA-J AM MED ASSOC, V213, P1143, DOI 10.1001/jama.1970.03170330025003
  • [4] [Anonymous], 1979, JAMA-J AM MED ASSOC, V242, P2562
  • [5] ACC/AHA Versus ESC/ESH on Hypertension Guidelines
    Bakris, George
    Ali, Waleed
    Parati, Gianfranco
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2019, 73 (23) : 3018 - 3026
  • [6] Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control
    Beddhu, Srinivasan
    Chertow, Glenn M.
    Cheung, Alfred K.
    Cushman, William C.
    Rahman, Mahboob
    Greene, Tom
    Wei, Guo
    Campbell, Ruth C.
    Conroy, Margaret
    Freedman, Barry I.
    Haley, William
    Horwitz, Edward
    Kitzman, Dalane
    Lash, James
    Papademetriou, Vasilios
    Pisoni, Roberto
    Riessen, Erik
    Rosendorff, Clive
    Watnick, Suzanne G.
    Whittle, Jeffrey
    Whelton, Paul K.
    [J]. CIRCULATION, 2018, 137 (02) : 134 - 143
  • [7] ISOLATED ELEVATION OF DIASTOLIC BLOOD-PRESSURE - REAL OR ARTIFACTUAL
    BLANK, SG
    MANN, SJ
    JAMES, GD
    WEST, JE
    PICKERING, TG
    [J]. HYPERTENSION, 1995, 26 (03) : 383 - 389
  • [8] Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up
    Carlsson, Axel C.
    Johansson, Sven-Erik
    Theobald, Holger
    Wandell, Per E.
    [J]. BLOOD PRESSURE MONITORING, 2013, 18 (02) : 72 - 77
  • [9] Differences in prevalence of hypertension subtypes according to the 2018 Korean Society of Hypertension and 2017 American College of Cardiology/American Heart Association guidelines: The Korean National Health and Nutrition Examination Survey, 2007-2017 (KNHANES IV-VII)
    Cho, So Mi Jemma
    Lee, Hokyou
    Kim, Hyeon Chang
    [J]. CLINICAL HYPERTENSION, 2019, 25 (01)
  • [10] Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
    Chobanian, AV
    Bakris, GL
    Black, HR
    Cushman, WC
    Green, LA
    Izzo, JL
    Jones, DW
    Materson, BJ
    Oparil, S
    Wright, JT
    Roccella, EJ
    [J]. HYPERTENSION, 2003, 42 (06) : 1206 - 1252