Isolated diastolic blood pressure and risk of atherosclerotic cardiovascular disease in a community dwelling population

Objective: Although the threshold of blood pressure (BP) for hypertension was lowered to 130/80 mmHg in the 2017 American college of cardiology (ACC)/American Heart Association (AHA) guidelines, the threshold of >=140/90 mmHg was still recommended in both the 2018 European Society of Cardiology (ESC) and 2019 National Institute for Health and Care Excellence (NICE) guideline. This study was to explore the clinical significance of isolated diastolic blood pressure for cardiovascular risk based on the two hypertension thresholds. Design and method: 6768 participants without antihypertensive treatment were included in the analysis of the association between isolated diastolic hypertension (IDH) and atherosclerotic cardiovascular risk. IDH was defined respectively by 2017 AHA/ACA guidelines (systolic BP < 130mmHg, diastolic BP >= 80mmHg) and by the ESC/NICE definition (systolic BP < 140mmHg, diastolic BP >=90mmHg). Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines. Results: The estimated prevalence of IDH was 24.0% by the 2017 ACC/AHA definition and 10.85% by the 2018 ESC/ 2019 NICE definition. Compared with normotensive individuals, those with IDH by both the 2017 ACC/AHA definition and the 2018 ESC/ 2019 NICE definition did not show any significant difference for the prevalence of ASCVD risk [Odds Ratio (OR) of 2017 ACC/AHA definition: 0.56, 95% confidence interval (CI):0.3–1.01; OR of 2018 ESC/ 2019 NICE definition: 1.43, 95%CI: 0.83–2.44]. The diagnostic efficiency of diastolic blood pressure is not significant (Area Under the ROC Curve: 0.51, 95%CI: 0.48–0.55). The dose-response relationship was validated by restricted cubic spline analysis (P for overall association = 0.57, P for non-linear association = 0.50). Conclusions: In this Chinese population, IDH is more prevalent when defined by the 2017 AHA/ACC definition compared with the 2018 ESC/ 2019 NICE definition. However, IDH as defined by either threshold is not significantly associated with increased ASCVD risk and its diagnostic efficacy is poor.