From the Guidelines
Diastolic hypotension is primarily caused by decreased peripheral vascular resistance, which allows blood to flow more easily through the arteries during the heart's resting phase, and can be a result of various factors including medications, endocrine disorders, autonomic nervous system dysfunction, and heart conditions.
Causes of Diastolic Hypotension
Some common causes of diastolic hypotension include:
- Vasodilator medications such as nitrates (nitroglycerin, isosorbide), calcium channel blockers (amlodipine, nifedipine), and alpha-blockers (prazosin, doxazosin) which relax blood vessel walls 1
- Phosphodiesterase inhibitors like sildenafil can also reduce diastolic pressure
- Endocrine disorders such as adrenal insufficiency (Addison's disease) and hypothyroidism may lead to diastolic hypotension due to impaired vascular tone
- Autonomic nervous system dysfunction, as seen in diabetic neuropathy or Parkinson's disease, disrupts normal blood pressure regulation 1
- Severe dehydration, blood loss, or sepsis can reduce blood volume and vascular filling, lowering diastolic pressure
- Heart conditions that impair ventricular filling or cardiac output, including severe heart failure or aortic regurgitation, may also contribute
Management of Diastolic Hypotension
Patients experiencing diastolic hypotension may feel dizzy, lightheaded, or fatigued, especially when standing up. Management typically involves:
- Addressing the underlying cause
- Adjusting medications
- Ensuring adequate hydration
- Sometimes adding medications that increase vascular tone if clinically indicated 1 It is essential to note that diastolic hypotension can be a significant concern, particularly in older adults, as it may increase the risk of falls, fractures, and mortality 1. Therefore, it is crucial to monitor blood pressure regularly, especially in older adults, and adjust treatment strategies accordingly to minimize the risk of diastolic hypotension.
From the Research
Causes of Diastolic Hypotension
- Diastolic hypotension can be caused by various factors, including endocrine disorders such as adrenal failure, isolated hypoaldosteronism, and pseudohypoaldosteronism 2
- It can also be a result of treatment-induced hypotension, particularly in patients with hypertension who are taking multiple antihypertensive medications 3
- Other potential causes of diastolic hypotension include:
- Beta-agonist use, particularly in children with asthma 4
- Orthostatic hypotension, which can be symptomatic or asymptomatic 5
- Chronic hypotension in people with heart failure, which can be an indicator of poor prognosis 5
- Age, diabetes, and isolated systolic hypertension, which can increase the risk of developing diastolic hypotension during therapy 3
Risk Factors for Diastolic Hypotension
- Older age 3
- Diabetes 3
- Higher baseline systolic blood pressure 3
- Lower baseline diastolic blood pressure 3
- Beta-agonist use, particularly in high doses 4
- Tachycardia, which can be associated with diastolic hypotension and increase the risk of myocardial injury 4
Clinical Significance of Diastolic Hypotension
- Diastolic hypotension can be an at-risk situation in very old and frail patients, as well as those with coronary heart disease 5
- It can also be associated with increased cardiovascular morbidity and mortality, particularly in patients with heart failure 6
- Diastolic hypotension can limit myocardial blood flow, particularly in the setting of beta-agonist-induced chronotropy and inotropy 4