Prevalence of isolated diastolic hypertension and other types of hypertension (isolated systolic hypertension, systolic-diastolic hypertension, and controlled hypertension), by age group.

Prevalence of isolated diastolic hypertension and other types of hypertension (isolated systolic hypertension, systolic-diastolic hypertension, and controlled hypertension), by age group.

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Background Characterizing and assessing the prevalence, awareness, and treatment patterns of patients with isolated diastolic hypertension ( IDH ) can generate new knowledge and highlight opportunities to improve their care. Methods and Results We used data from the China PEACE (Patient‐centered Evaluative Assessment of Cardiac Events) Million Per...

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... were encouraged to participate in the project through publicity campaigns in the newspaper and on the television. Of the 2 351 035 participants aged 35 to 75 years enrolled at these sites between September 15, 2014 andMay 29, 2018, we excluded 14 904 participants because of missing or extreme blood pressure values (systolic blood pressure [SBP] <70 or >270 mm Hg; diastolic blood pressure [DBP] <30 or >150 mm Hg), 142 participants due to missing or extreme body mass index values (<10 or >50 kg/m 2 ), and 25 805 participants due to missing data on covariates, including geographical region, education, occupation, marital status, household income, and alcohol use ( Figure S1). ...
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... prevalence of IDH decreased with age, whereas the prevalence of other hypertension subtypes (including ISH, SDH and controlled hypertensives) increased with age ( Figure 1). The prevalence of IDH was significantly higher for men (4.5% of overall population and 9.8% of hypertensives) as compared with women (2.2% of overall population and 5.2% of hypertensives; Table 2). ...
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... participants with IDH N (%) 63112 10167 Age (years) Figure S1. Flowchart of study participant selection in China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project. Figure S2. ...

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... Our study also expanded the previous study, 2,7 showing the prototypal obese HFpEF phenotype-representative of the Chinese population, which were roughly two decade younger compared with patients with HFpEF and normal weight group. This may help understand the actual distribution of the population with obesity-the young and middleaged males in China, 25,26 and put a heavier burden in medical management. The present data also confirmed and extended previous studies, 2,7 showing that patients with HFpEF and obesity had worse cardiac remodeling-higher LVMi, LVEDVi, LVESVi, while relatively lower LAVi, when compared with patients with HFpEF and normal weight by the Chinese obesity criteria. ...
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... Due to the concept that "SBP is the most important", the awareness and treatment of DBP in hypertensive patients is very low [55]; for example, according to the data of the PEACE Million People Project, in China the awareness rate is 10.3% and the untreated rate is 86.1% [56]. Concordant elevations in both SBP and DBP pose the greatest risk for cardiovascular disease-related mortality [57]. ...
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... Essential hypertension, also known as primary hypertension, is the most common risk factor for cardiovascular diseases [1,2]. Therefore, it is imperative to control hypertension in daily life. ...
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... Our findings are in accordance with data in the Korean population (10), although the rise in IDH prevalence is considered the major contributor to the increase in hypertension. We believe that this difference could be explained by the older population in our study (≥45 years), as previous evidence has indicated that IDH is commonly found in young participants (19,20). Several studies have reported the impact on the prevalence of recommended antihypertensive medication from the 2017 ACC/AHA guideline (5,8,21). ...
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... Mahajan Model 1 is adjusted for sex, age; model 2 is adjusted for model 1 plus body mass index, bust and heart rate at baseline; model 3 is adjusted for model 2 plus smoking, drinking, family history of hypertension, fasting plasma glucose and serum uric acid at follow-up. With increasing age, there was a gradual shift from IDH to ISH and mixed hypertension [23]. From these, the younger the age, the more likely the prevalence of IDH. ...
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Background: Data on the association of isolated diastolic hypertension (IDH) in childhood with adult cardiovascular risk are scarce. This study aimed to estimate the prevalence of IDH in adolescents and to explore the impact of IDH in childhood on adult subclinical target organ damage (STOD). Methods: This longitudinal study consisted of 1738 school children (55.4% boys) aged 6-15 years from rural areas of Hanzhong, Shaanxi, who were followed for 30 years. Their blood pressure was recorded to define the hypertension subtypes: normotension, IDH, isolated systolic hypertension (ISH) and mixed hypertension. Tracked STOD included arterial stiffness (n = 1738), albuminuria (n = 1652) and left ventricular hypertrophy (LVH) (n = 1429). Results: Overall, the prevalence of IDH, ISH and mixed hypertension was 5.4, 2.2 and 3%, respectively, and there was no gender difference. Over 30 years, 366 (21.1%) of participants developed arterial stiffness, 170 (10.3%) developed albuminuria and 68 (4.8%) developed LVH. Compared with normotensive participants, IDH in childhood had higher risk ratio (RR) of experiencing arterial stiffness (RR, 1.66; 95% CI, 1.01-2.76) and albuminuria (RR, 2.27; 95% CI, 1.35-4.16) in adults after being fully adjusted but not LVH. However, if the elevated blood pressure in children was used as the reference standard, IDH in childhood was associated with adult LVH (RR, 2.48; 95% CI, 1.28-4.84). Conclusion: IDH accounts for a higher proportion of adolescent hypertension subtypes and can increase the risk of adult STOD. These results highlight the necessity of improving the prevention, detection and treatment of IDH in adolescents.
... WHO reported that the cost of chronic diseases, mainly hypertension and its complications, and the loss of labour force have seriously hindered the development of the global economy (Organization, 2002). (Mahajan et al., 2019). A study conducted in Jiangsu province showed that the rates of awareness, treatment and control of hypertension were 56.6%, 45.3% and 12.0% (standardized rates: 52.2%, 41.0% and11.2%), ...
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Aim To investigate the status and predictors of self-care among older adults with hypertension in China by the Chinese version of Self-Care of Hypertension Inventory. Design A cross-sectional questionnaire survey. Methods A convenience sampling of 544 older adults with hypertension was surveyed using the Chinese version of Self-Care of Hypertension Inventory. SPSS25.0 software was used for statistical analysis of the data. Generalized liner model univariate analysis and the optimal scaling regression analysis were performed to investigate the predictors of self-care. Results The status of self-care was poor with the median and inter-quartile range of total scores of self-care (140.00 ± 67), the scores of self-care maintenance (50 ± 24.76), the scores of self-care management (56.25 ± 29.41) and the scores of self-care confidence (54.79 ± 29.17). Age, family model, primary caregiver, maximum systolic blood pressure, coverage of medical insurance, disease duration, receiving self-care education, education level, economic burden and family history of hypertension were the most powerful predictors of self-care among older adults with hypertension.
... However, IDH has usually been neglected and the treatment and awareness rates of this condition remain low. A previous study demonstrated that 86.1% of patients with IDH did not receive treatment and only 10.3% of untreated patients knew that they had hypertension (6). The number of deaths from cardiovascular events reached 17.7 million in 2017, accounting for approximately one-third of the total deaths (55 million) worldwide (7). ...
... Data from the National Health and Nutrition Examination Survey (NHANES) III cohort in America demonstrated that awareness among patients with IDH (46.8%) was significantly lower than patients with isolated systolic hypertension (ISH) (58.4%) and combined systolic and diastolic hypertension (SDH) (67.2%) (33). Data from the China PEACE Million Persons Project indicated that awareness among patients with IDH was 10.3% and that 86.1% of these were untreated (6). Moreover, the observed discrepancy may also reflect the genetic susceptibility and lifestyle differences between different regions (34)(35)(36)(37). ...
... Isolated diastolic hypertension results from an increase in peripheral vascular resistance and is more prevalent in young and middle-aged adults (6,22,(38)(39)(40). Chrysant observed that IDH was associated with an adverse cardiovascular events in younger patients (32). ...
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Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q -test and I ² statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test. Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07–1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07–1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04–2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18–2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97–1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87–2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events. Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians. Trial Registration: PROSPERO, Identifier: CRD42021254108.
... 5,6 Despite its low prevalence, IDH affects a non-negligible number of Chinese people considering the large Chinese population; moreover, the awareness regarding IDH is low and it is often poorly managed. 7 Previous studies have shown that IDH (SBP <140 mm Hg and DBP ≥90 mm Hg) is more prevalent in younger adults, and is associated with future systolic hypertension. [8][9][10][11][12][13] The 2017 hypertension guideline issued by the American College of Cardiology/American Heart Association (ACC/AHA) lowered the threshold of blood pressure and redefined IDH as SBP <130 mm Hg and DBP ≥80 mm Hg. 5 . ...
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The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the threshold (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] ≥80 mm Hg) for isolated diastolic hypertension (IDH), whereas the 2018 Chinese guideline still recommends the old threshold (SBP <140 mm Hg and DBP ≥90 mm Hg). This study aimed to investigate the association between IDH, as defined by both guidelines, and the risk of incident cardiovascular disease (CVD) in rural areas of northeast China. This prospective study included participants whose baseline data were collected between 2004 and 2006. The exclusion criteria were baseline CVD, incomplete data, and systolic hypertension. The primary end point was incident CVD, a composite end point including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death. Multivariate Cox models were used to evaluate the association of IDH with CVD risk. The authors analyzed 19 688 participants (7140 participants with IDH) according to the ACC/AHA guideline. Compared with normotensive participants, individuals with ACC/AHA-defined IDH were at a high risk of CVD (HR = 1.177, 95% CI: 1.035–1.339). A similar difference in CVD risk was noted when normotensive participants were compared with those with IDH, determined based on the 2018 Chinese guideline (HR = 1.218, 95% CI: 1.050–1.413). Similar results were found in participants who did not take antihypertensives at baseline. Moreover, IDH defined by either guideline was significantly associated with nonfatal MI. ACC/AHA-defined IDH was associated with a risk of CVD, implying that blood pressure management should be improved in rural areas of China.