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Diastolic Morning Surge Improves Risk Stratification for Subclinical Left Ventricular Diastolic Dysfunction in

Ayhan Cosgun1, Huseyin Oren2

  • 1Department of Cardiology, TC Saglik Bakanligi Cihanbeyli Devlet Hastanesi, Cihanbeyli, Konya, Turkey.

Journal of Clinical Hypertension (Greenwich, Conn.)
|June 15, 2026
PubMed

Insights

Isolated diastolic hypertension (IDH) is linked to early heart changes. Assessing the diastolic morning surge (DMS) improves risk prediction for left ventricular diastolic dysfunction (LVDD) in patients with IDH.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Diagnostic Imaging

Background:

  • Isolated diastolic hypertension (IDH) is often underestimated regarding cardiovascular risk.
  • Sustained diastolic pressure and dynamic circadian variations, like the diastolic morning surge (DMS), may contribute to myocardial remodeling.
  • Subclinical left ventricular diastolic dysfunction (LVDD) is an early indicator of cardiac changes.

Purpose of the Study:

  • To investigate the association between ambulatory-defined IDH and subclinical LVDD.
  • To determine if incorporating the diastolic morning surge (DMS) improves risk stratification for LVDD in IDH patients.
  • To evaluate the incremental value of DMS in identifying LVDD beyond mean blood pressure.

Main Methods:

  • Cross-sectional study of 737 untreated adults undergoing 24-h ambulatory blood pressure monitoring and echocardiography.
  • IDH defined by 24-h mean diastolic blood pressure ≥80 mmHg and systolic pressure <130 mmHg.
  • LVDD diagnosed using 2016 ASE/EACVI criteria; DMS assessed from ambulatory monitoring data.

Main Results:

  • IDH was independently associated with LVDD (OR 2.79).
  • The addition of DMS provided independent incremental information for LVDD risk (OR 1.44 per 5 mmHg).
  • Incorporating DMS improved model discrimination (AUC 0.76 to 0.81, p=0.041), calibration, and clinical benefit.

Conclusions:

  • Ambulatory-defined IDH is significantly associated with subclinical LVDD.
  • Assessing dynamic diastolic load via DMS offers valuable incremental information for risk stratification and phenotypic characterization of LVDD.
  • DMS assessment enhances the understanding of cardiovascular risk in patients with isolated diastolic hypertension.

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