Abstract P147: Cumulative Diastolic Blood Pressure Burden In Normal Systolic Blood Pressure And Cardiovascular Disease

Abstract

Introduction: The clinical significance of isolated diastolic hypertension defined by the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) Guideline remains controversial. We examined whether long-term diastolic burden independently predicts the first major adverse cardiovascular event (MACE) in participants with sustained untreated normal systolic BP. Methods: We identified 18,181 Mass General Brigham Biobank participants aged 18 to 64 years with untreated systolic BP <130 mmHg. Cumulative diastolic burden was determined as the area under curve for diastolic BP (DBP) ≥80 mmHg over a 5-year period prior to enrollment. Hazard ratio (HR) between cumulative diastolic burden and MACE was estimated using Cox proportional hazards regression. Prognostic value of enrollment and cumulative DBP was compared. Results: Of the 18,181 participants, mean [SD] age at enrollment was 47.6 [14.3] years, 13,574 [74.7%] were female, and 2853 (15.7%) MACE occurred over a median [IQR] follow-up of 3.5 [1.9-5.3] years. Each SD increase in cumulative DBP was associated with HR (95% CI) of 1.07 (1.03-1.11), adjusting for age, sex, race, body mass index, systolic BP, lipids, diabetes, smoking, statin, and antihypertensives initiation during follow-up. In addition to traditional risk factors, cumulative DBP improved the discrimination C index (95% CI) from 0.732 (0.724-0.742) to 0.739 (0.732-0.748) (Likelihood ratio test P =0.021), whereas inclusion of enrollment DBP did not improve prognosis. Conclusions: Among individuals with normal systolic BP, cumulative DBP may augment risk stratification beyond a single DBP measure and other traditional risk factors.