What is diastolic hypertension?

From the Guidelines

Diastolic hypertension is defined as a diastolic blood pressure of 80 mmHg or higher, and it is a significant risk factor for cardiovascular disease and microvascular complications, particularly in individuals with diabetes. According to the standards of medical care for patients with diabetes mellitus 1, hypertension is a common comorbidity of diabetes, affecting 20–60% of people with diabetes. The study emphasizes the importance of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in persons with diabetes, and suggests a target blood pressure goal of <130/80 mmHg if it can be safely achieved.

Key Points

• Diastolic hypertension is a major risk factor for CVD and microvascular complications such as retinopathy and nephropathy 1
• Randomized clinical trials have demonstrated the benefit of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in persons with diabetes 1
• Lifestyle modifications, including reducing sodium intake, adopting the DASH diet, regular exercise, limiting alcohol consumption, maintaining healthy weight, and quitting smoking, are recommended as first-line treatment
• Medication therapy, including ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics, may be necessary if blood pressure remains elevated despite lifestyle changes

Treatment Goals

• Treatment goals typically aim for diastolic readings below 80 mmHg, though targets may be individualized based on age and comorbidities
• Regular monitoring is essential, with home readings taken twice daily for accurate assessment
• The goal of treatment is to reduce the risk of heart disease, stroke, and kidney damage, particularly in younger individuals where diastolic hypertension may indicate increased peripheral vascular resistance 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, The FDA drug label does not explicitly define diastolic hypertension.

• Diastolic pressure is mentioned as a factor that contributes to increased cardiovascular risk when elevated. However, the label does not provide a direct definition of diastolic hypertension 2.

From the Research

Definition of Diastolic Hypertension

• Diastolic hypertension is defined as a diastolic blood pressure (DBP) of at least 80 mm Hg 3
• It is a component of hypertension, which is a major risk factor for cardiovascular disease (CVD) events, such as coronary heart disease, heart failure, and stroke 3

Diagnosis and Treatment

• The diagnosis of diastolic hypertension is based on the measurement of DBP, which is typically performed using a sphygmomanometer 3
• Treatment of diastolic hypertension typically involves lifestyle modifications, such as weight loss, healthy dietary patterns, physical activity, and moderation of alcohol consumption 3, 4
• Pharmacologic therapy, including thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers, may also be necessary to control DBP 3, 5, 6

Clinical Significance

• Diastolic hypertension is associated with increased risk of CVD events and mortality 3, 5
• Reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years 6
• The goal of treatment is to achieve a DBP of less than 80 mm Hg, although this may vary depending on individual patient characteristics and comorbidities 3, 7, 6