Isolated diastolic hypertension and its risk factors in semi-rural population of South India

Prevalence and determinants of isolated systolic and isolated diastolic hypertension in India: Insights from the national family health survey (NFHS)- 4

Background

Isolated Systolic Hypertension (ISH) and Isolated Diastolic Hypertension (IDH) are often the ignored forms of hypertension and are determinants of future cardiac and neurological events and contribute to mortality. However, the nationally representative estimates of both these forms of hypertension remain unknown from India.

Aim

To estimate the ISH and IDH from a nationally representative survey of India.

Material and Methods

The present study used data from 7,23,181 people (15-54 years), recorded during the fourth round (2015-2016) of the National Family Health Survey (NFHS), India. The prevalence of ISH and IDH was calculated for state comparison, while multilevel logistic regression analysis was done to assess the correlates of both types of hypertension.

Results

The prevalence of ISH and IDH was found to be 1.2% (95% CI 1.0-1.4) and 5.7% (95% CI 5.2-6.2), respectively. The prevalence of both ISH and IDH increased with age, with a more significant increase in systolic pressure towards the higher age. Northeastern states of India (Assam, Meghalaya, and Arunachal Pradesh) had the highest prevalence of both forms of hypertension. On multilevel logistic regression, male gender, increasing age groups (highest odds ratio (OR) being in 45-49 year age group), alcohol, and diabetes positively predicted both ISH and IDH. Urban residence, literacy, and tobacco were positive predictors of IDH, whereas urban residence, smoking, and literacy negatively predicted ISH.

Conclusion

ISH and IDH have a significant presence among the population of India. This data provides insights to formulate strategies at the primary and primordial prevention levels.

The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey

Background

Hypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tends to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) to find a more efficient way to improve the management.

Methods

Patients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017–2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg.

Results

A total of 8548 patients were screened, and 8475 participants were included. The average age was 63.67 ± 12.78 years, and males accounted for 54.4%. Among them, 361 (4.3%) had IDH, and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) were much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Multivariate logistic regression analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05–1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95–1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04–1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90–1.21, p = 0.653).

Conclusions

Patients with IDH were much younger, and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH.

Trial registration

NCT03862183, retrospectively registered on March 5, 2019.

Association between body mass index and hypertension subtypes in Indian and United States adults

The purpose of this cross-sectional, secondary analysis was to determine the association between BMI & lipids and hypertension subtype in U.S. and Indian adults. Obese BMI was significantly associated with isolated diastolic hypertension (IDH) compared to low/normal BMI (relative risk ratio [95% CI]; U.S.: 4.33 [2.88,6.52]; India: 2.51 [2.41,2.60]). Furthermore, BMI was more strongly associated with IDH than other hypertension subtypes in U.S. and non-obese Indian adults. In obese Indian adults, we observed higher odds of isolated systolic hypertension until the 6th decade, and systo-diastolic hypertension thereafter. Triglyceride levels were associated with IDH in U.S. adults (1.94 [1.43,2.63]).