Isolated diastolic hypertension and cardiovascular outcomes across different diagnostic guidelines: a systematic review and meta-analysis

Abhimanyu Agarwal, Mohamed A. Mostafa, Muhammad Imtiaz Ahmad, Elsayed Z. Soliman
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Abstract

This systematic review aims to determine the impact of isolated diastolic hypertension (IDH) on cardiovascular outcomes. We searched only English language articles on PubMed and SCOPUS until July 31, 2023 to investigate the association between IDH and cardiovascular outcomes. This meta-analysis of 19 studies evaluated the impact of different hypertension diagnostic guidelines (ACC/AHA: American Heart Association/American College of Cardiology; JNC7: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NICE/ESC: National Institute for Health and Care Excellence/European Society of Cardiology) on hypertension-related outcomes. Studies had varying sample sizes (173 to 2,969,679 participants) and study designs. In cohort studies using JNC7 guidelines, IDH was linked to increased cardiovascular disease (CVD) risk (HR: 1.45, 95% CI 1.17, 1.74), CVD mortality (HR: 1.54, 95% CI 1.23, 1.84), and coronary heart disease (CHD) risk (HR: 1.65). In studies using ACC/AHA guidelines, associations with CVD risk and CVD mortality were weaker [HR: 1.16 (95% CI 1.06, 1.25) and 1.10 (95% CI 0.95, 1.25), respectively]. Subgroup analysis revealed differences in outcomes on the basis of age and sex. Cross-sectional studies did not show significant associations with JNC7 and ACC guidelines; NICE guidelines were not used in cross-sectional studies. IDH is associated with an increased risk of CVD. Higher diastolic blood pressure cutoffs were associated with higher cardiovascular risk. This association varied by study design and effect modification by sex and race influenced the association.
不同诊断指南中的孤立舒张期高血压和心血管后果:系统回顾和荟萃分析
本系统综述旨在确定孤立性舒张性高血压(IDH)对心血管预后的影响。截至 2023 年 7 月 31 日,我们仅在 PubMed 和 SCOPUS 上检索了英文文章,以研究 IDH 与心血管预后之间的关联。这项包含 19 项研究的荟萃分析评估了不同高血压诊断指南(ACC/AHA:美国心脏协会/美国心脏病学会;JNC7:高血压预防、检测、评估和治疗联合国家委员会;NICE/ESC:NICE/ESC:美国国家健康与护理卓越研究所/欧洲心脏病学会)关于高血压相关结果的研究。这些研究的样本量(173 到 2,969,679 名参与者)和研究设计各不相同。在采用 JNC7 指南的队列研究中,IDH 与心血管疾病 (CVD) 风险增加(HR:1.45,95% CI 1.17,1.74)、CVD 死亡率(HR:1.54,95% CI 1.23,1.84)和冠心病 (CHD) 风险增加(HR:1.65)有关。在使用 ACC/AHA 指南的研究中,与心血管疾病风险和心血管疾病死亡率的相关性较弱[HR:分别为 1.16(95% CI 1.06,1.25)和 1.10(95% CI 0.95,1.25)]。亚组分析显示,不同年龄和性别的结果存在差异。横断面研究未显示与 JNC7 和 ACC 指南有显著关联;横断面研究未使用 NICE 指南。IDH 与心血管疾病风险增加有关。舒张压临界值越高,心血管风险越高。这种关联因研究设计的不同而不同,性别和种族对关联的影响也不同。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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