What is the diagnosis and treatment for Diastolic Hypertension (HTN)?

From the Guidelines

Diastolic hypertension should be treated with a goal of achieving readings below 130/80 mmHg, with lifestyle modifications and medication therapy, including ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers, as needed. When managing diastolic hypertension, it is essential to consider the potential risks and benefits of treatment, as evidenced by the SHEP investigators who found that an achieved diastolic pressure of less than 70 mmHg, and especially below 60 mmHg, identifies a high-risk group that has a poorer outcome 1.

Key Considerations

• Lifestyle modifications, such as reducing sodium intake, regular exercise, weight loss, limiting alcohol consumption, and following the DASH diet, should be initiated first 1.
• Medication therapy, including ACE inhibitors like lisinopril (10-40mg daily) or ARBs like losartan (25-100mg daily), thiazide diuretics like hydrochlorothiazide (12.5-25mg daily), and calcium channel blockers like amlodipine (5-10mg daily), may be added if lifestyle modifications are insufficient 1.
• Regular blood pressure monitoring is crucial to achieve the goal of readings below 130/80 mmHg.
• The choice of first-line medication should be tailored to individual patient characteristics, particularly in older patients who may have other risk factors, target organ damage, and associated cardiovascular or non-cardiovascular clinical conditions 1.

Additional Guidance

• A blocker of the renin-angiotensin system should be a regular component of combination treatment and the one preferred when monotherapy is sufficient 1.
• Microalbuminuria should prompt the use of antihypertensive drug treatment, even when initial BP is in the high normal range, with blockers of the renin-angiotensin system being preferred due to their pronounced antiproteinuric effect 1.
• Treatment strategies should consider an intervention against all cardiovascular risk factors, including the use of a statin 1.

From the FDA Drug Label

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit Diastolic Hypertension is a condition where the diastolic blood pressure is elevated, which can increase the risk of cardiovascular events.

• The treatment goal is to lower blood pressure to reduce the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions.
• Lisinopril 2 and Amlodipine 3 are indicated for the treatment of hypertension, including diastolic hypertension, to lower blood pressure.
• Hydrochlorothiazide 4 is also used to treat hypertension, but it is a diuretic and works differently than lisinopril and amlodipine.

From the Research

Definition and Prevalence of Diastolic Hypertension

• Diastolic hypertension is defined as a diastolic blood pressure (DBP) of at least 80 mm Hg 5.
• Hypertension, including diastolic hypertension, affects approximately 116 million adults in the US and more than 1 billion adults worldwide 5.

Treatment and Management of Diastolic Hypertension

• First-line therapy for hypertension, including diastolic hypertension, is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption 5, 6.
• When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers 5, 6.
• Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years 6.
• A blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus 6.

Benefits of Lowering Diastolic Blood Pressure

• Lowering diastolic blood pressure can reduce the risk of cardiovascular disease (CVD) events, including coronary heart disease, heart failure, and stroke 5, 7.
• An SBP reduction of 10 mm Hg decreases the risk of CVD events by approximately 20% to 30% 5.
• Physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 8.

Comparison of Different Treatments for Diastolic Hypertension

• Thiazide-type diuretics are superior in preventing one or more major forms of CVD and are less expensive, and should be preferred for first-step antihypertensive therapy 7.
• The combination of a calcium channel blocker and an angiotensin-converting enzyme inhibitor can have a significant additional blood pressure lowering effect compared to monotherapy 9.