Isolated Diastolic Hypertension and Cardiovascular Disease Risk in Young Adults

Abstract

Background: Whether isolated diastolic hypertension (IDH) in young adults represents a benign, age-specific phenotype or confers increased cardiovascular disease (CVD) risk remains uncertain. We assessed the associations between hypertension subtypes - IDH, isolated systolic hypertension (ISH), and systolic-diastolic hypertension (SDH) - with atherosclerotic CVD (ASCVD) and heart failure (HF), and characterized longitudinal transitions in hypertension subtypes from young adulthood into later life. Methods: Adults aged ≥18 years without CVD were included from four US cohorts. Hypertension subtypes were defined using BP thresholds of ≥130/80 mm Hg. Cox proportional hazard models estimated the associations between hypertension subtypes with ASCVD and HF. Results: Among 23,957 participants (mean age 44.5 years, 42.5% young adults aged 18–39 years, 45.1% male), 2,320 ASCVD and 1,243 HF events occurred over a median follow-up of 17.2 years. In young adults, the adjusted hazard ratios (HR [95% CI]) for ASCVD were 1.36 (1.11–1.68) for IDH, 1.54 (1.02–2.32) for ISH, and 1.84 (1.46–2.32) for SDH, compared to normotension. Corresponding HRs for HF were 1.69 (1.24–2.31) for IDH, 1.92 (1.09–3.40) for ISH, and 1.69 (1.17–2.43) for SDH. Associations were consistent among adults aged ≥40 years. In young adults with IDH, 29.8% remained with IDH while 36.5% progressed to SDH later in life. Conclusions: IDH in young adulthood represents an early marker of elevated CVD risk and a precursor to more adverse hypertension subtypes. These findings underscore the importance of early recognition, ongoing BP monitoring, and guideline-concordant pharmacologic treatment when indicated among young adults with IDH to reduce long-term CVD risk.