The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey

Kun Xie, Xiufang Gao, Liwen Bao, Ying Shan, Haiming Shi, Yong Li, Kun Xie, Xiufang Gao, Liwen Bao, Ying Shan, Haiming Shi, Yong Li

Abstract

Background: Hypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tends to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) to find a more efficient way to improve the management.

Methods: Patients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017-2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg.

Results: A total of 8548 patients were screened, and 8475 participants were included. The average age was 63.67 ± 12.78 years, and males accounted for 54.4%. Among them, 361 (4.3%) had IDH, and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) were much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Multivariate logistic regression analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05-1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95-1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04-1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90-1.21, p = 0.653).

Conclusions: Patients with IDH were much younger, and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH.

Trial registration: NCT03862183 , retrospectively registered on March 5, 2019.

Keywords: Aging; Body mass index; Isolated diastolic hypertension; Isolated systolic hypertension; Smoking.

Conflict of interest statement

The authors declare that there is no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The proportion of IDH and ISH in patients with hypertension according to age categories/ IDH: isolated diastolic hypertension. ISH: isolated systolic hypertension. SDH: systolic and diastolic hypertension. Different dimensions along with the horizontal axis are related to sample proportions
Fig. 2
Fig. 2
OR for the prevalence of IDH and ISH. A. OR for the prevalence of IDH; B. OR for the prevalence of ISH. IDH: isolated diastolic hypertension. ISH: isolated systolic hypertension

References

    1. Mahajan S, Zhang D, He S, Lu Y, Gupta A, Spatz ES, Lu J, Huang C, Herrin J, Liu S, Yang J, Wu C, Cui J, Zhang Q, Li X, Nasir K, Zheng X, Krumholz HM, Li J, China PEACE Collaborative Group § Prevalence, awareness, and treatment of isolated diastolic hypertension: insights from the China PEACE million persons project. J Am Heart Assoc. 2019;8(19):e012954. doi: 10.1161/JAHA.119.012954.
    1. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr, Collins KJ, Dennison Himmelfarb C, et al. 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: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(6):1269–1324. doi: 10.1161/HYP.0000000000000066.
    1. McEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, et al. Association of Isolated Diastolic Hypertension as defined by the 2017 ACC/AHA blood pressure guideline with incident cardiovascular outcomes. JAMA. 2020;323(4):329–338. doi: 10.1001/jama.2019.21402.
    1. Qi Y, Han X, Zhao D, Wang W, Wang M, Sun J, Liu J, Li Y, Gao S, Hao Y, Deng Q, Liu J. Long-term cardiovascular risk associated with stage 1 hypertension defined by the 2017 ACC/AHA hypertension guideline. J Am Coll Cardiol. 2018;72(11):1201–1210. doi: 10.1016/j.jacc.2018.06.056.
    1. Wei J, Galaviz KI, Kowalski AJ, Magee MJ, Haw JS, Narayan KMV, Ali MK. Comparison of cardiovascular events among users of different classes of antihypertension medications: a systematic review and network Meta-analysis. JAMA Netw Open. 2020;3(2):e1921618. doi: 10.1001/jamanetworkopen.2019.21618.
    1. Lee H, Yano Y, Cho SMJ, Park JH, Park S, Lloyd-Jones DM, Kim HC. Cardiovascular risk of isolated systolic or diastolic hypertension in young adults. Circulation. 2020;141(22):1778–1786. doi: 10.1161/CIRCULATIONAHA.119.044838.
    1. Chang TE, Ritchey MD, Park S, Chang A, Odom EC, Durthaler J, Jackson SL, Loustalot F. National Rates of nonadherence to antihypertensive medications among insured adults with hypertension, 2015. Hypertension. 2019;74(6):1324–1332. doi: 10.1161/HYPERTENSIONAHA.119.13616.
    1. Sheriff HM, Tsimploulis A, Valentova M, Anker MS, Deedwania P, Banach M, Morgan CJ, Blackman MR, Fonarow GC, White M, Alagiakrishnan K, Allman RM, Aronow WS, Anker SD, Ahmed A. Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: insights from the cardiovascular health study. Int J Cardiol. 2017;238:140–143. doi: 10.1016/j.ijcard.2017.02.142.
    1. Niiranen TJ, Rissanen H, Johansson JK, Jula AM. Overall cardiovascular prognosis of isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home measurements: the Finn-home study. J Hypertens. 2014;32(3):518–524. doi: 10.1097/HJH.0000000000000070.
    1. Wang Y, Xing F, Liu R, Liu L, Zhu Y, Wen Y, Sun W, Song Z. Isolated diastolic hypertension associated risk factors among Chinese in Anhui Province, China. Int J Environ Res Public Health. 2015;12(4):4395–4405. doi: 10.3390/ijerph120404395.
    1. Timpson NJ, Harbord R, Davey Smith G, Zacho J, Tybjaerg-Hansen A, Nordestgaard BG. Does greater adiposity increase blood pressure and hypertension risk?: Mendelian randomization using the FTO/MC4R genotype. Hypertension. 2009;54(1):84–90. doi: 10.1161/HYPERTENSIONAHA.109.130005.
    1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, ESC Scientific Document Group. de Backer G, Heagerty AM, Agewall S, Bochud M, Borghi C, Boutouyrie P, Brguljan J, Bueno H, Caiani EG, Carlberg B, Chapman N, Cífková R, Cleland JGF, Collet JP, Coman IM, de Leeuw PW, Delgado V, Dendale P, Diener HC, Dorobantu M, Fagard R, Farsang C, Ferrini M, Graham IM, Grassi G, Haller H, Hobbs FDR, Jelakovic B, Jennings C, Katus HA, Kroon AA, Leclercq C, Lovic D, Lurbe E, Manolis AJ, McDonagh TA, Messerli F, Muiesan ML, Nixdorff U, Olsen MH, Parati G, Perk J, Piepoli MF, Polonia J, Ponikowski P, Richter DJ, Rimoldi SF, Roffi M, Sattar N, Seferovic PM, Simpson IA, Sousa-Uva M, Stanton AV, van de Borne P, Vardas P, Volpe M, Wassmann S, Windecker S, Zamorano JL, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet JP, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh TA, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Zamorano JL, Tsioufis C, Lurbe E, Kreutz R, Bochud M, Rosei EA, Jelakovic B, Azizi M, Januszewics A, Kahan T, Polonia J, van de Borne P, Williams B, Borghi C, Mancia G, Parati G, Clement DL, Coca A, Manolis A, Lovic D, Benkhedda S, Zelveian P, Siostrzonek P, Najafov R, Pavlova O, de Pauw M, Dizdarevic-Hudic L, Raev D, Karpettas N, Linhart A, Olsen MH, Shaker AF, Viigimaa M, Metsärinne K, Vavlukis M, Halimi JM, Pagava Z, Schunkert H, Thomopoulos C, Páll D, Andersen K, Shechter M, Mercuro G, Bajraktari G, Romanova T, Trušinskis K, Saade GA, Sakalyte G, Noppe S, DeMarco DC, Caraus A, Wittekoek J, Aksnes TA, Jankowski P, Polonia J, Vinereanu D, Baranova EI, Foscoli M, Dikic AD, Filipova S, Fras Z, Bertomeu-Martínez V, Carlberg B, Burkard T, Sdiri W, Aydogdu S, Sirenko Y, Brady A, Weber T, Lazareva I, Backer TD, Sokolovic S, Jelakovic B, Widimsky J, Viigimaa M, Pörsti I, Denolle T, Krämer BK, Stergiou GS, Parati G, Trušinskis K, Miglinas M, Gerdts E, Tykarski A, de Carvalho Rodrigues M, Dorobantu M, Chazova I, Lovic D, Filipova S, Brguljan J, Segura J, Gottsäter A, Pechère-Bertschi A, Erdine S, Sirenko Y, Brady A. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339.
    1. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1–253.
    1. He H, Pa L, Pan L, Simayi A, Mu H, Abudurexiti Y, Tao N, Shan G. Effect of BMI and its optimal cut-off value in identifying hypertension in Uyghur and Han Chinese: a Biethnic study from the China National Health Survey (CNHS) Int J Hypertens. 2018;2018:1508083–1508088. doi: 10.1155/2018/1508083.
    1. Wang J, Zhu Y, Jing J, Chen Y, Mai J, Wong SH, et al. Relationship of BMI to the incidence of hypertension: a 4 years' cohort study among children in Guangzhou, 2007-2011. BMC Public Health. 2015;15(1):782. doi: 10.1186/s12889-015-1997-6.
    1. Arima H, Anderson C, Omae T, Woodward M, Hata J, Murakami Y, MacMahon S, Neal B, Chalmers J, for the PROGRESS Collaborative Group Effects of blood pressure lowering on major vascular events among patients with isolated diastolic hypertension: the perindopril protection against recurrent stroke study (PROGRESS) trial. Stroke. 2011;42(8):2339–2341. doi: 10.1161/STROKEAHA.110.606764.
    1. Strandberg TE, Salomaa VV, Vanhanen HT, Pitkala K, Miettinen TA. Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years. J Hypertens. 2002;20(3):399–404. doi: 10.1097/00004872-200203000-00014.
    1. Li Y, Wei FF, Thijs L, Boggia J, Asayama K, Hansen TW, Kikuya M, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Gu YM, Torp-Pedersen C, Dolan E, Liu YP, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Mena L, Maestre GE, Filipovský J, Imai Y, O'Brien E, Wang JG, Staessen JA, International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators Ambulatory hypertension subtypes and 24-hour systolic and diastolic blood pressure as distinct outcome predictors in 8341 untreated people recruited from 12 populations. Circulation. 2014;130(6):466–474. doi: 10.1161/CIRCULATIONAHA.113.004876.
    1. Wei FF, Li Y, Zhang L, Xu TY, Ding FH, Staessen JA, Wang JG. Association of target organ damage with 24-hour systolic and diastolic blood pressure levels and hypertension subtypes in untreated Chinese. Hypertension. 2014;63(2):222–228. doi: 10.1161/HYPERTENSIONAHA.113.01940.
    1. Mittal C, Singh M, Bakhshi T, Ram Babu S, Rajagopal S, Ram CVS. Isolated diastolic hypertension and its risk factors in semi-rural population of South India. Indian Heart J. 2019;71(3):272–276. doi: 10.1016/j.ihj.2019.07.007.
    1. Li Y, Wei FF, Wang S, Cheng YB, Wang JG. Cardiovascular risks associated with diastolic blood pressure and isolated diastolic hypertension. Curr Hypertens Rep. 2014;16(11):489. doi: 10.1007/s11906-014-0489-x.
    1. McEniery CM, Yasmin WS, Maki-Petaja K, Mcdonnell B, Sharman JE, et al. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension. 2005;46(1):221–226. doi: 10.1161/01.HYP.0000165310.84801.e0.
    1. Citoni B, Figliuzzi I, Presta V, Cesario V, Miceli F, Bianchi F, et al. Prevalence and clinical characteristics of isolated systolic hypertension in young: analysis of 24 h ambulatory blood pressure monitoring database. J Hum Hypertens. 2021. 10.1038/s41371-021-00493-9.
    1. Xie K, Bao L, Jiang X, Ye Z, Bing J, Dong Y, Gao D, Ji X, Jiang T, Li J, Li Y, Luo S, Mao W, Peng D, Qu P, Song S, Wang H, Wang Z, Xu B, Yin X, Yu Z, Zhang X, Zhang Z, Zhu Z, Gao X, Li Y. The association of metabolic syndrome components and chronic kidney disease in patients with hypertension. Lipids Health Dis. 2019;18(1):229. doi: 10.1186/s12944-019-1121-5.
    1. Fan B, Yang Y, Dayimu A, Zhou G, Liu Y, Li S, Chen W, Zhang T, Xue F. Body mass index trajectories during young adulthood and incident hypertension: a longitudinal cohort in Chinese population. J Am Heart Assoc. 2019;8(8):e011937. doi: 10.1161/JAHA.119.011937.
    1. Zhang DY, Huang JF, Kang YY, Dou Y, Su YL, Zhang LJ, Cheng YB, Guo QH, Huang QF, Li Y, Wang JG. The prevalence of masked hypertension in relation to cigarette smoking in a Chinese male population. J Hypertens. 2020;38(6):1056–1063. doi: 10.1097/HJH.0000000000002392.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi