Fang J, Madhavan S, Cohen H, Alderman MH
Isolated diastolic hypertension: A favorable finding among young and middle-aged hypertensive patients

Hypertension (Sep) 26:377-382 1995

Long term prognosis of patients with narrow pulse pressure, normal systolic blood pressure, but isolated diastolic hypertension (IDH) has been unclear in the published literature. In this epidemiological study, Fang et al examined 965 patients with IDH (<160/>90 mm Hg) and compared the incidence of myocardial infarction (MI) over an average 4.5 year follow up with 595 patients with combined systolic/diastolic hypertension (>160/>90 mm Hg). All patients were less than 60 years old. Exact pharmacologic treatment data was not reported. Comorbid conditions and associated risk factors and demographic characteristics were identified and patients with SDH were older, more often female, tobacco smokers, hyperlipidemic, hyperglycemic, and had LVH by ECG criteria in comparison to IDH patients. The authors claim to have corrected for these obviously influential factors through a Cox multivariate analysis.

Age adjusted incidence for MI per 1000 person-years was 5.2 in the SDH group vs. 2.31 in the IDH group (RR 2.31 vs. 1.00 respectively, hazards ratio 2.11). Interestingly, no patient with IDH and an initial systolic blood pressure less than 140 mm Hg suffered an MI during the study period. Furthermore, a wide pretreatment pulse pressure (held by previous authors to predict cardiovascular risk) was found in this study to have a linear and independent correlation with MI (hazards ratio 1.54). An accompanying article in the September issue of Hypertension by Blank et al (26:383-389, 1995) suggests that auscultory technique in the setting of a narrow pulse pressure overestimates "true" diastolic values by 5 mm Hg or more, supplying some explanation for the findings contained in this study. While MI appears less common with IDH in comparison with SDH truly long term prospective data are still unavailable. (Narsipur)

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H: Pathophysiology : Age-related norms
H: Diagnosis : Young adult through middle age





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