From the Guidelines
Diastolic hypertension is primarily caused by a combination of lifestyle factors, underlying medical conditions, and genetic predispositions, with the most significant contributors being increased peripheral vascular resistance, obesity, high sodium intake, chronic kidney disease, and endocrine disorders, as outlined in 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. The main causes of diastolic hypertension can be broken down into several key categories, including:
- Lifestyle factors, such as physical inactivity, excessive alcohol consumption, smoking, and chronic stress, which contribute to increased blood pressure
- Underlying medical conditions, including chronic kidney disease, endocrine disorders like primary aldosteronism or thyroid dysfunction, and sleep apnea, which disrupt blood pressure regulation
- Genetic factors, with family history being a strong predictor of hypertension
- Certain medications, such as NSAIDs, corticosteroids, and some antidepressants, which can raise diastolic blood pressure
- Other factors, including aging, which naturally stiffens blood vessels, and high sodium intake, which leads to fluid retention, as noted in the guideline 1. It is essential to identify and address these underlying causes to effectively manage diastolic hypertension, and the guideline provides a comprehensive framework for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
From the Research
Causes of Diastolic Hypertension
- Diastolic hypertension is a major reversible risk factor for cardiovascular complications 2
- The risks conferred by diastolic blood pressure are age-dependent, with diastolic blood pressure driving coronary risk in younger subjects 2
- Isolated diastolic hypertension (IDH) is associated with adverse cardiovascular events in younger persons and should be treated 3
- IDH often manifests in concurrence with other cardiovascular risk factors, and individuals with IDH tend to have lower awareness of their hypertension 4
- Sleep apnea, hypertension, and resistant hypertension have close relations and can lead to target organ damage, including the kidney, which may contribute to the development of diastolic hypertension 5
Risk Factors
- Age: diastolic blood pressure drives coronary risk in younger subjects, while systolic blood pressure is the predominant risk indicator in older people 2
- Cardiovascular risk factors: IDH often manifests in concurrence with other cardiovascular risk factors 4
- Sleep apnea: severe sleep apnea is an independent risk factor for chronic kidney disease, which may contribute to the development of diastolic hypertension 5
- Resistant hypertension: resistant hypertension is an independent risk factor for chronic kidney disease and can contribute to the development of diastolic hypertension 5
Clinical Significance
- IDH is a largely underrated risk factor for cardiovascular disease events 4
- The clinical relevance of IDH differs by individual clinical characteristics, and detailed phenotyping is necessary to assess an individual's expected net benefit from therapy 4
- Treatment of IDH in older subjects should be individualized to avoid further decrease in normal systolic blood pressure and prevent the onset of adverse cardiovascular events 3