LAUSR

Objective: 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. Design and method: We studied 68 non-diabetic, first diagnosed and never-treated hypertensive patients with IDH (mean age = 49 + 9, 65% males, 24% smokers) and 30 normotensives (mean age = 51 + 10, 17% males, 20% smokers). Office and ambulatory blood pressure monitoring (24 h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), 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 and smoking habit, decreased LDL-C and increased diastolic (89 + 9 vs. 84 + 9 mmHg, p = 0.02) and mean office BP (106 + 9 vs. 99 + 12 mmHg, p = 0.01) as well as 24 h systolic (126 + 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 increased LVMI (78 + 17 vs. 68 + 19 g/m2, p = 0.03) and IMT (0.9 + 0.1 vs. 0.8 + 0.1 mm, p = 0.03) but similar PWV, E/Ea and CFR compared to normotensives. LVMI was related to diastolic (r = 0.32, p = 0.008) and mean (r = 0.32, p = 0.01) office BP in IDH patients. Conclusions: The presence of HMOD in patients with first diagnosed and never treated IDH 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.