Isolated systolic, diastolic hypertension up risk of CVD

Isolated systolic hypertension (ISH) appears to heighten the risk of most cardiovascular disease (CVD) events, suggests a study. Additionally, the association between isolated diastolic hypertension (IDH) and CVD risk is primarily caused by the incidence of myocardial infarction (MI) and CVD death.

The authors obtained data from the UK Biobank study and categorized participants into five groups: normal blood pressure (BP), normal high BP, ISH, IDH, and systolic and diastolic hypertension. The primary endpoint was the composite of nonfatal MI, nonfatal ischaemic stroke, nonfatal haemorrhagic stroke, and CVD death. The results for these outcomes were explored separately. BP at baseline were measured twice after the participants had been at rest for at least 5 min in a seated position.

In total, 385,995 participants who were not taking antihypertensive medications, were free of CVD at baseline, and had available data on BP measurements were included in the analysis. Over a median 8.1 years of follow-up, 8,959 CVD events were recorded, including 4,729 nonfatal MIs, 2,287 nonfatal ischaemic strokes, 813 nonfatal haemorrhagic strokes, and 1,826 CVD deaths.

Based on the hypertension threshold of at least 130/80 mm Hg by the American College of Cardiology/American Heart Association guidelines, both ISH (hazard ratio [HR], 1.39, 95 percent confidence interval [CI], 1.27–1.15) and IDH (HR, 1.28, 95 percent CI, 1.15–1.43) contributed to an increase in overall CVD risk relative to normal BP.

ISH also correlated with most CVD risk, except for ischaemic stroke. On the other hand, the excess CVD risk associated with IDH appeared to be driven by MI and CVD death. Heterogeneity by sex and age was noted concerning the effects of IDH on overall CVD risk, with significant associations in younger adults (aged <60 years) and women and null associations in men and older adults (aged ≥60 years).

“Further research is needed to identify participants with IDH who have a particular risk for developing CVD,” the authors said.