Temporal trends of isolated diastolic hypertension among US adults in 1999–2018: A serial cross-sectional study

Objectives: Isolated diastolic hypertension (IDH) has 2 different definitions according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) and the 2018 European Heart Association (ESC) and the European Hypertension Association (ESH) hypertension guidelines. However, little is known about the temporal trends of IDH among US adults according to the 2018 ESC/ESH hypertension guidelines. This study aimed to assess 20-year trends of IDH by 2018 ESC/ESH definition and the difference between the 2 definitions among US adults. Methods: A total of 44,656 participants aged 18 years or older (mean age, 46.2 years [standard error, 0.20]; 22,109 [49.5%] men) from the cross-sectional National Health and Nutrition Examination Survey between 1999 and 2018 were included. IDH was defined by the ESC/ESH guidelines (systolic blood pressure [BP] of <140 mm Hg with diastolic BP of ≥90 mm Hg) and the ACC/AHA guidelines (systolic BP of <130 mm Hg with diastolic BP of ≥80 mm Hg). Results: From 1999 to 2018, the estimated age-standardized prevalence of IDH was 2.1% (95% confidence interval [CI], 1.9%–2.4%) by the ESC/ESH definition and 9.4% (95% CI, 9.0%–9.9%) by the ACC/AHA definition (absolute difference, 7.3% [95% CI, 6.9%–7.7%]). For IDH by the ESC/ESH definition, the estimated age-standardized prevalence decreased from 2.5% (95% CI, 1.7%–3.3%) in 1999–2002 to 1.7% (95% CI, 1.2%–2.1%) in 2011–2014 ( P = 0.011 for trend) and then increased to 2.3% (95% CI, 1.7%–2.9%) in 2015–2018 ( P = 0.002 for trend). The differences in prevalence of IDH between both definitions from 1999–2002 to 2015–2018 ranged from 6.3% (5.2%–7.3%) to 9.5% (8.5%–10.6%). Using the ESC/ESH definition, the estimated prevalence of IDH was higher in middle-aged adults (3.3% versus 2.0%; multivariable-adjusted odds ratio [OR], 1.52 [95% CI, 1.24–1.86]) and lower in older adults (0.6% versus 2.0%; multivariable-adjusted OR, 0.26 [95% CI, 0.18–0.38]) compared with young adults. It was estimated that the prevalence was higher among male versus female adults (3.1% versus 1.1%; multivariable-adjusted OR, 2.77 [95% CI, 2.26–3.39]). Conclusion: In this analysis of US adults, the estimated prevalence of IDH decreased significantly from 1999–2002 to 2011–2014 and subsequently increased during 2015–2018 according to the 2018 ESC/ESH definition. The estimated prevalence of IDH under the ACC/AHA definition was substantially higher than that under the ESC/ESH definition, while the former may lead to potential overdiagnosis and overtreatment in US adults.