Does a diastolic blood pressure range of 90-98 mmHg signify diastolic dysfunction?

Elevated Diastolic Blood Pressure vs. Diastolic Dysfunction

Having a diastolic blood pressure ranging from 90-98 mmHg does not signify diastolic dysfunction; these are two entirely different medical concepts. 1

Understanding Diastolic Blood Pressure

Diastolic blood pressure is the pressure in your arteries when your heart is between beats (at rest). According to the 2024 ESC guidelines for hypertension management:

• Normal diastolic BP: <80 mmHg
• Elevated diastolic BP: 80-89 mmHg
• Stage 1 diastolic hypertension: 80-89 mmHg
• Stage 2 diastolic hypertension: ≥90 mmHg 1

Your readings of 90-98 mmHg indicate:

• You have diastolic hypertension (≥90 mmHg)
• This requires medical attention and treatment

Understanding Diastolic Dysfunction

Diastolic dysfunction refers to abnormal cardiac relaxation, filling, or distensibility - a completely different concept from diastolic blood pressure. It relates to how well your heart's left ventricle relaxes and fills with blood between contractions.

Diastolic dysfunction is diagnosed through specific cardiac imaging tests:

• Echocardiography showing:
  • Abnormal mitral inflow patterns
  • Reduced tissue velocities (e' <8 cm/s septal, <10 cm/s lateral)
  • Elevated E/e' ratio (>15 indicating high filling pressures)
  • Left atrial enlargement (volume >34 mL/m²) 1

Relationship Between Hypertension and Diastolic Dysfunction

While your elevated diastolic blood pressure doesn't mean you have diastolic dysfunction, there is an important relationship:

• Hypertension is the most important risk factor for developing diastolic dysfunction 2
• About 50% of patients with hypertension eventually develop diastolic dysfunction 3
• Hypertension promotes diastolic dysfunction through:
  • Left ventricular hypertrophy (thickening of heart muscle)
  • Increased myocardial fibrosis
  • Decreased ventricular compliance 4

Management Recommendations

For your diastolic hypertension (90-98 mmHg):

1. Initiate antihypertensive treatment since your diastolic BP is consistently ≥90 mmHg 1

2. Target blood pressure goals:

   • General target: <80 mmHg for diastolic BP 1
   • Optimal target: 70-79 mmHg for diastolic BP 5

3. Medication options:

   • ACE inhibitors or ARBs are often first-line options
   • Calcium channel blockers, diuretics may be added
   • Combination therapy often needed 1

4. Lifestyle modifications:

   • Reduce sodium intake (<2,300 mg/day)
   • DASH-style eating pattern
   • Regular physical activity
   • Weight loss if overweight
   • Limit alcohol consumption 5

Important Considerations

• Diastolic BP should generally not be lowered below 70 mmHg, particularly in patients with coronary artery disease, to ensure adequate coronary perfusion 5
• If you develop symptoms like dizziness, fatigue, or syncope with treatment, your medication regimen may need adjustment 5
• Regular monitoring of your blood pressure is essential to ensure proper control

When to Consider Diastolic Dysfunction Evaluation

Consider cardiac evaluation for diastolic dysfunction if you develop:

• Unexplained shortness of breath
• Exercise intolerance
• Symptoms of heart failure despite normal ejection fraction

Remember that controlling your hypertension now is the best strategy to prevent the development of diastolic dysfunction in the future.