From the Guidelines
High diastolic blood pressure is primarily caused by lifestyle factors such as obesity, high sodium intake, alcohol consumption, physical inactivity, and certain medications, as well as underlying medical conditions like kidney disease, thyroid problems, and sleep apnea. These factors contribute to increased resistance in the small blood vessels, making it harder for blood to flow through them. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, various environmental exposures, including components of diet, physical activity, and alcohol consumption, influence blood pressure. The guideline highlights that poor diet, physical inactivity, and excess intake of alcohol are the underlying cause of a large proportion of hypertension.
Some of the key factors associated with high diastolic blood pressure include:
- Overweight and obesity
- Excess intake of sodium
- Insufficient intake of potassium, calcium, magnesium, protein, fiber, and fish fats
- Physical inactivity
- Excess intake of alcohol
- Certain medications like NSAIDs or decongestants
- Medical conditions such as kidney disease, thyroid problems, sleep apnea, and hormonal disorders
- Genetics, as family history of hypertension increases risk
To manage high diastolic blood pressure, lifestyle modifications are recommended, including reducing sodium intake to less than 2,300mg daily, exercising regularly, maintaining a healthy weight, limiting alcohol, quitting smoking, and managing stress 1. If these measures are insufficient, medications like ACE inhibitors, ARBs, calcium channel blockers, or diuretics may be prescribed. It is essential to address high diastolic blood pressure, as it increases the risk of heart disease, stroke, and kidney damage, especially when readings consistently exceed 80 mmHg.
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 The reason why diastolic is high is not directly stated in the provided drug labels. High diastolic pressure is mentioned as a cause of increased cardiovascular risk. No specific cause for high diastolic pressure is given in the labels 2 3.
From the Research
Reasons for High Diastolic Blood Pressure
- High diastolic blood pressure can be caused by various factors, including secondary hypertension, which can be multifactorial 4
- Isolated diastolic hypertension is a type of hypertension where only the diastolic blood pressure is elevated, and it can be a risk factor for cardiovascular complications, especially in younger subjects 5
- The risks associated with diastolic blood pressure are age-dependent, with diastolic blood pressure driving coronary risk in younger subjects, while systolic blood pressure is the predominant risk indicator in older people 5
Treatment of High Diastolic Blood Pressure
- Combination antihypertensive therapy is often required to achieve target blood pressure goals, and the choice of add-on therapy can depend on various factors, including the presence of renal disease 4
- Thiazide diuretics may be beneficial for blood pressure control in patients with advanced chronic kidney disease, despite previous concerns about their effectiveness in this population 6
- The treatment of isolated diastolic hypertension should be individualized, especially in older subjects, where further lowering of diastolic blood pressure may not be beneficial and could even increase the risk of adverse cardiovascular events 7
Clinical Significance of Isolated Diastolic Hypertension
- The prevalence of isolated diastolic hypertension has increased with the new 2017 ACC/AHA blood pressure treatment guidelines, and its clinical significance as a cause of adverse cardiovascular events is still debated 7
- Isolated diastolic hypertension is more common in younger subjects, who are at low cardiovascular risk, and is rare in older subjects, who are at increased cardiovascular risk 7
- The decision to treat isolated diastolic hypertension should be based on individual factors, including age, cardiovascular risk, and the potential benefits and risks of treatment 7