From the Guidelines
Diastolic hypertension is primarily caused by increased peripheral vascular resistance in the small arteries and arterioles, and several factors contribute to this condition, including arterial stiffness, endothelial dysfunction, and sympathetic nervous system overactivity, as noted in the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline 1. The condition occurs when the heart is relaxing between beats (diastole) and blood pressure remains abnormally high, typically above 80 mmHg. Some of the key factors that contribute to diastolic hypertension include:
- Arterial stiffness
- Endothelial dysfunction
- Sympathetic nervous system overactivity
- Renin-angiotensin-aldosterone system activation Common risk factors for diastolic hypertension include:
- Aging
- Obesity
- High sodium intake
- Physical inactivity
- Excessive alcohol consumption
- Chronic stress Medical conditions such as kidney disease, thyroid disorders, and sleep apnea can also lead to diastolic hypertension, as highlighted in the 2007 European Society of Hypertension guidelines 1. Genetics play a significant role as well, with family history being a strong predictor. Treatment typically involves lifestyle modifications like reducing sodium intake, maintaining healthy weight, regular exercise, limiting alcohol, and managing stress. If these measures are insufficient, medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics may be prescribed based on individual patient factors, as recommended in the 2003 Joint National Committee guidelines 1. Addressing diastolic hypertension is crucial as it increases the risk of heart disease, stroke, kidney damage, and other cardiovascular complications, as emphasized in the 2009 American College of Cardiology Foundation/American Heart Association task force report 1. The current recommendations for hypertension management, as outlined in the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline, suggest treating to <140/90 mmHg or <130/80 mmHg in patients with diabetes mellitus or chronic kidney disease 1.
From the Research
Causes of Diastolic Hypertension
- Diastolic hypertension can be caused by various factors, including lifestyle habits and physiological mechanisms 2, 3, 4
- Studies have shown that unhealthy lifestyle factors such as poor diet, physical inactivity, smoking, and excessive alcohol consumption can contribute to the development of diastolic hypertension 2, 4
- Physiological mechanisms underlying diastolic hypertension include vascular endothelial dysfunction, oxidative stress, inflammation, and autonomic function 3, 4
Lifestyle Interventions for Diastolic Hypertension
- Lifestyle interventions such as healthy diet, physical activity, stress management, and sleep patterns have been shown to be effective in reducing diastolic blood pressure 2, 3, 5, 6
- A combination of healthy diet and physical activity has been found to be the most effective lifestyle intervention for reducing diastolic blood pressure, with a mean reduction of -6.28 mmHg 2
- Other lifestyle interventions such as stress management and sleep patterns have also been found to be effective in reducing diastolic blood pressure, although the evidence is less consistent 3, 6
Mechanisms Underlying Lifestyle Interventions
- The mechanisms underlying the beneficial effects of lifestyle interventions on diastolic hypertension include improvements in vascular health, reduction in sympathetic overactivation, and increased secretion of myokines 3
- Lifestyle interventions can also modulate visceral fat accumulation, insulin resistance, and the renin-angiotensin-aldosterone system, which can contribute to the development of diastolic hypertension 4