Bismillah, alhamdulillah.

If you try and work out the risk of cardiovascular disease using the Framingham calculator or other tools such as QRISK then you when you come to entering your patient’s blood pressure you will see that the only number required is the systolic blood pressure. What happened to the diastolic blood pressure?

Well the simple answer is that these are usually raised in both cases and adding the diastolic data into a predictive model does not result in a meaningful change in the risk. So this raises the question about what happens to patients with isolated diastolic hypertension (IDH)? Well I did not know so I thought I would briefly revise the topic and see what was new. A summary from UpToDate is as follows:

  • IDH is defined as a Systolic <140mmHg but diastolic >90mmHg
  • Large (No 3267) 32 year prospective Finnish study found no increase in all cause mortality in healthy men with IDH
  • But the Framingham Heart Study showed 55% progressed to SDH (Systolic & Diastolic Hypertension) within 7 years
  • 10yr prospective Chinese study (No 26,500) found an increased risk of stroke RR 2.16 in patient with IDH.

To sum it all up, if they are fit and healthy with no evidence of end organ damage, not Chinese and have no hypothyroidism (associated with IDH) then conservative management with advice on lifestyle measures and monitoring for SDH is a valid option.


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