Isolated diastolic hypertension is not a benign situation regarding hypertension mediated organ damage in patients with first diagnosed and never treated essential hypertension

Abstract Background Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects. Methods From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject. Results IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p<0.001) as well as 24h systolic (125±3 vs. 119±6 mmHg, p<0.001) and diastolic ABPM (84±4 vs. 73±4 mmHg, p<0.001) compared to normotensives. Regarding HMOD, IDH patients had LVH in 7/81 (9%). Increased LVMI (79±18 vs. 69±18 g/m2, p=0.01) and IMT (0.9±0.2 vs. 0.8±0.1 mm, p=0.01) but similar PWV, E/Ea and CFR were found compared to normotensives. In multiple regression analysis (age and weight were used as independent variables), LVMI was independently related to office systolic (Beta=0.26, p=0.02) and diastolic BP (Beta=0.28, p=0.01) as well as central diastolic BP (r=0.38, p=0.04) while no relationship was found between LVMI and 24h ABPM. Conclusions The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients. Funding Acknowledgement Type of funding sources: None.