Association of Isolated Diastolic Hypertension as Defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure Guideline With Incident Cardiovascular Outcomes
Authors' conclusion
In this analysis of US adults, the estimated prevalence of IDH was more common when defined by the 2017 ACC/AHA BP guideline compared with the JNC7 guideline. However, IDH was not significantly associated with increased risk for cardiovascular outcomes.
Study context
- Population
- US adults (NHANES 2013–2016; Atherosclerosis Risk in Communities (ARIC) Study, baseline 1990–1992, follow-up through December 31, 2017)NHANES 9590
- Exposure
- Isolated diastolic hypertension (IDH) by 2017 ACC/AHA definition vs Joint National Committee (JNC7) definition; IDH vs normotension
- Outcome
- Weighted prevalence of IDH in US adults and of adults recommended blood pressure (BP) pharmacotherapy solely for IDH; risk of incident atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and chronic kidney disease (CKD) (ARIC)
Methodological detailsexternal validation in 2 cohorts (NHANES III/1999-2014, CLUE II)
- External validation in 2 cohorts (NHANES III/1999-2014, CLUE II)
Main finding
As reported in the abstract
Prevalence of IDH (NHANES) and incident outcomes (ARIC)
Absolute difference (95% CI)
IDH (2017 ACC/AHA) vs IDH (JNC7)prevalence
5.2%(4.7%–5.7%)
Hazard ratio (95% CI)
IDH (2017 ACC/AHA) vs Normotensiveincident ASCVD (n = 1386 events; median follow-up 25.2 years)
1.06(0.89–1.26)
IDH (2017 ACC/AHA) vs NormotensiveHF (n = 1396 events)
0.91(0.76–1.09)
IDH (2017 ACC/AHA) vs NormotensiveCKD (n = 2433 events)
0.98(0.65–1.11)
- Newly classified IDH also meeting threshold for antihypertensive therapy
- 0.6% (95% CI, 0.5%-0.6%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CV mortality, external cohortsIDH (2017 ACC/AHA) vs Normotensive · NHANES (n = 1012 events) | 1.17 (0.87–1.56) | |
| CV mortality, external cohortsIDH (2017 ACC/AHA) vs Normotensive · CLUE II (n = 1497 events) | 1.02 (0.92–1.14) | |
| 0.512Hazard ratio (log scale) |
Original publication
Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA. Published 28 January 2020. doi:10.
Summarised from the published abstract; every number is checked against it