Université de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome, Italy.
Clin Cardiol. 2021 Nov;44(11):1516-1525. doi: 10.1002/clc.23713. Epub 2021 Sep 15.
Isolated diastolic hypertension (IDH) is defined as diastolic blood pressure (DBP) ≥80 mmHg and systolic blood pressure (SBP) <130 mmHg according to 2017 ACC/AHA guidelines. The effective cardiovascular risk linked to IDH is debated.
IDH might contribute marginally to hypertension-related target organ damage (TOD) development.
In this cross-sectional analysis 1605 subjects from the STANISLAS cohort, a large familiar longitudinal study from Eastern France, were included. Participants were categorized according to average values at 24-h ABP recording as having normal BP (SBP < 130/DBP < 80 mmHg); combined hypertension (SBP ≥130/DBP ≥80 mmHg or on antihypertensive treatment); IDH (SBP <130/DBP >80 mmHg); isolated systolic hypertension (ISH: SBP ≥130/DBP <80 mmHg). The association between hypertension status and TOD was assessed by multivariable-adjusted logistic models.
Using normotension as reference, IDH was not significantly associated with NTproBNP levels (adjusted odds ratio [OR] 1.04 [95%CI 0.82;1.32], p = .750), microalbuminuria (OR 0.99 [0.69; 1.42], p = .960), diastolic dysfunction (OR 1.53 [0.88; 2.68], p = .130), left ventricular (LV) mass index (OR per 10 g/m increase 1.07 [0.95; 1.21], p = .250), LV longitudinal strain (global: OR 1.07 [0.99; 1.14], p = .054; subendocardial: OR 1.06 [0.99; 1.13], p = .087), carotid intima media thickness (OR 1.27 [0.79; 2.06], p = .320), reduced ankle-brachial index (<0.9; OR 1.59 [0.19; 13.55], p = .670) and pulse wave velocity (PWV; OR 1.07 [0.93; 1.23], p = .360). In contrast, combined hypertension and ISH were independently associated with LV mass index and PWV increase (all p ≤ .01).
IDH was not significantly associated with TOD. Further studies are needed to clarify the clinical role of IDH. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01391442.
根据 2017 年 ACC/AHA 指南，孤立性舒张期高血压（IDH）定义为舒张压（DBP）≥80mmHg 和收缩压（SBP）<130mmHg。与 IDH 相关的有效心血管风险存在争议。
IDH 可能对高血压相关的靶器官损害（TOD）的发展有一定的影响。
在这项来自法国东部的大型家族纵向研究 STANISLAS 队列的横断面分析中，纳入了 1605 名受试者。根据 24 小时动态血压监测的平均值，将参与者分为正常血压（SBP<130/DBP<80mmHg）；合并高血压（SBP≥130/DBP≥80mmHg 或正在接受降压治疗）；IDH（SBP<130/DBP>80mmHg）；单纯收缩期高血压（ISH：SBP≥130/DBP<80mmHg）。使用多变量调整的逻辑模型评估高血压状态与 TOD 之间的关联。
以正常血压为参照，IDH 与 NTproBNP 水平（调整后的比值比 [OR] 1.04 [95%CI 0.82；1.32]，p=0.750）、微量白蛋白尿（OR 0.99 [0.69；1.42]，p=0.960）、舒张功能障碍（OR 1.53 [0.88；2.68]，p=0.130）、左心室（LV）质量指数（每增加 10g/m 的 OR 为 1.07 [0.95；1.21]，p=0.250）、LV 纵向应变（整体：OR 1.07 [0.99；1.14]，p=0.054；心内膜下：OR 1.06 [0.99；1.13]，p=0.087）、颈动脉内膜中层厚度（OR 1.27 [0.79；2.06]，p=0.320）、踝臂指数降低（<0.9；OR 1.59 [0.19；13.55]，p=0.670）和脉搏波速度（PWV；OR 1.07 [0.93；1.23]，p=0.360）无显著相关性。相比之下，合并高血压和 ISH 与 LV 质量指数和 PWV 增加独立相关（均 p≤0.01）。
IDH 与 TOD 无显著相关性。需要进一步的研究来阐明 IDH 的临床作用。
