Isolated diastolic hypertension and target organ damage: Findings from the STANISLAS cohort

Abstract

Background: Isolated diastolic hypertension (IDH) is defined as diastolic blood pressure (DBP) ≥80 mmHg and systolic blood pressure (SBP) <130 mmHg according to 2017 ACC/AHA guidelines. The effective cardiovascular risk linked to IDH is debated. Hypothesis: IDH might contribute marginally to hypertension-related target organ damage (TOD) development. Methods: In this cross-sectional analysis 1605 subjects from the STANISLAS cohort, a large familiar longitudinal study from Eastern France, were included. Participants were categorized according to average values at 24-h ABP recording as having normal BP (SBP < 130/DBP < 80 mmHg); combined hypertension (SBP ≥130/DBP ≥80 mmHg or on antihypertensive treatment); IDH (SBP <130/DBP >80 mmHg); isolated systolic hypertension (ISH: SBP ≥130/DBP <80 mmHg). The association between hypertension status and TOD was assessed by multivariable-adjusted logistic models. Results: Using normotension as reference, IDH was not significantly associated with NTproBNP levels (adjusted odds ratio [OR] 1.04 [95%CI 0.82;1.32], p = .750), microalbuminuria (OR 0.99 [0.69; 1.42], p = .960), diastolic dysfunction (OR 1.53 [0.88; 2.68], p = .130), left ventricular (LV) mass index (OR per 10 g/m 2 increase 1.07 [0.95; 1.21],

Computational analysis of the role of mechanosensitive Notch signaling in arterial adaptation to hypertension

“…3H ) and IDH ( Fig. 4H ), which agrees with experimental observations ( Manios et al, 2015 ; Monzo et al, 2021 ). These results suggest the hypothesis that Notch mechanosensitivity is involved not only in the establishment of arterial homeostasis ( Loerakker et al, 2018 ), but also in its maintenance.…”

“…The stretch distributions were then used as input for the simulation of Notch signaling and, consequently, the prediction of the VSMC phenotypes in the arterial wall. Previous experimental studies have demonstrated that all three types of hypertension result in a thickening of arteries ( Al-Nimer et al, 2010 ; Chen et al, 2011 ; Manios et al, 2015 ; Monzo et al, 2021 ). A synthetic phenotype of VSMCs, inducing arterial G&R, is therefore expected in all these situations.…”

“…Inspired by this, here we compared three hypotheses, namely that Notch signaling in arteries is responsive to either systolic stretch, mean stretch, or dynamic stretch. Three types of hypertension were simulated, each of which is known to result in arterial wall thickening ( Al-Nimer et al, 2010 ; Chen et al, 2011 ; Manios et al, 2015 ; Monzo et al, 2021 ). Given the key role of synthetic VSMCs in G&R ( Owens et al, 2004 ; Rensen et al, 2007 ; Frismantiene et al, 2018 ), we assumed that arterial thickening would occur only when the simulations predicted a shift to synthetic VSMCs in the arterial wall.…”

Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension—Con Side of the Argument

“…7 Another cross-sectional analysis of 1605 French adults in the longitudinal STANISLAS cohort study found that IDH by the ACC/AHA definition was not significantly associated with markers of target organ damage including natriuretic peptides, microalbuminuria, diastolic dysfunction, left ventricular mass, carotid intimal thickness, ankle-brachial indices, and pulse-wave velocity. 30 While existing evidence does not support an association between IDH and subclinical atherosclerosis or target organ damage, it is worth noting that IDH, by both the old and the new definitions, is a strong risk factor for the future development of systolic hypertension. A landmark analysis of the Framingham Heart Study with 5209 participants found that those with IDH by JNC/ESC/ NICE definition were 23 times more likely to develop combined SDH, compared with participants who were normotensive.…”

A fluid-structure interaction model accounting arterial vessels as a key part of the blood-flow engine for the analysis of cardiovascular diseases

“…13 that blood flow volume would be reduced by 18.2%. Long-term sustained isolated diastolic hypertension causes insufficient blood supply to the body, which is clinically manifested as heat discomfort, dizziness, listlessness of spirit, and weakness of limbs, among other symptoms (Chrysant 2020;Monzo et al, 2021).…”