Should BP Be Lowered in Isolated Diastolic Hypertension?
Should BP Be Lowered in Isolated Diastolic Hypertension?
Source (Secondary):
Medscape , December 17, 2025
Primary Source:
European Heart Journal Dec— Key Points
• Large evidence base: Individual participant data meta-analysis of 51 randomized controlled trials including 358,325 adults.
• Definition used: Isolated diastolic hypertension (IDH) = SBP <130 mm Hg with DBP ≥80 mm Hg (alternative definition also tested).
• Population: Only 4.4% had IDH, but outcomes were robust across subgroups.
• Main finding:
• A 5-mm Hg reduction in systolic BP was associated with an approximately 10% reduction in major cardiovascular events, both in patients with and without IDH.
• Consistency across DBP levels:
• Benefit of lowering systolic BP was similar across all diastolic BP ranges, even when baseline DBP was <60 mm Hg.
• No effect modification:
• Benefits did not differ by age, prior cardiovascular disease, prior antihypertensive use, or BP measurement method.
• Clinical implication:
• Challenges the idea that IDH is a benign condition or should be excluded from BP-lowering treatment decisions.
• Guideline impact:
• Supports a more inclusive, risk-based approach to antihypertensive therapy rather than rigid BP phenotype definitions.
• Caveat:
• Dedicated randomized trials comparing tight vs less tight BP targets specifically in IDH are still needed.
