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[What can we think about diastolic hypertension?]
1Service de Médecine Interne et Hypertension Artérielle, CHU Purpan, Toulouse.
Insights
Isolated diastolic hypertension, a condition affecting younger individuals, involves elevated diastolic pressure without high systolic pressure. Specific medications like ACE inhibitors are recommended over others for this hypertension type.
Area of Science:
- Cardiology
- Vascular Biology
Context:
- Isolated diastolic hypertension (IDH) is not a formally recognized hypertensive disorder.
- IDH is characterized by diastolic pressure > 90 mm Hg and systolic pressure < 140 mmHg.
- This condition reflects increased arteriolar resistance with preserved large vessel compliance, typically seen in younger patients without significant vascular aging factors.
Purpose:
- To define isolated diastolic hypertension (IDH).
- To explore the underlying pathophysiology of IDH.
- To suggest optimal pharmacological management strategies for IDH.
Summary:
- IDH is defined by specific pressure thresholds and implies arteriolar vasoconstriction with maintained aortic distensibility.
- Pathophysiologically, it may involve increased adrenergic tone or plasma renin activity without impaired systolic function.
- Recommended treatments include angiotensin-converting enzyme inhibitors and calcium channel blockers, potentially more effective than diuretics or beta-blockers.
Impact:
- Clarifies the definition and characteristics of isolated diastolic hypertension.
- Provides insights into the pathophysiology, differentiating it from other hypertensive forms.
- Offers evidence-based recommendations for pharmacotherapy, guiding clinical practice for a specific patient group.
Abstract:
Isolated diastolic hypertension is not officially recognized as a form of hypertension. It is currently defined as a diastolic pressure greater than 90 mm Hg with systolic pressure < 140 mmHg. It implies an elevation of vascular resistance in the arteriolar sector and small arteries, and persistence of distensibility of the aorta and large vessels. It therefore predominantly affects young patients with relatively recent HT, without any accentuation of aging of the vessel wall by smoking, diabetes, or atheroma. It is responsible for a reduction of pulse pressure, and does not appear to be associated with deterioration of the prognosis. The demonstration of diastolic HT indicates the presence of excess adrenergic tone with predominance of alpha tone, or raised plasma renin, in the absence of any alteration of myocardial function capable of reducing systolic pressure. Monotherapy with angiotensin converting enzyme inhibitors, which reduce stimulation of growth of smooth muscle fibres, and calcium channel blockers, whose effects increase with increasing vasoconstrictor tone, would be preferable to diuretics and non-selective beta-blockers.