Blood pressure-lowering for prevention of major cardiovascular diseases in isolated diastolic hypertension: an individual participant-level data meta-analysis of randomised controlled trials

Journal article

Background and Aims: Blood Pressure (BP) lowering reduces cardiovascular disease (CVD) risk, however, the benefits of treating patients with normal systolic BP but elevated diastolic BP remain uncertain.
Methods: Data from 51 randomised controlled trials were pooled to compare BP-lowering effects in participants with and without isolated diastolic hypertension (IDH), defined as systolic BP <130 mmHg and diastolic BP ≥80 mmHg. Treatment effects were stratified across baseline diastolic BP categories (range <60 to ≥90) among individuals with baseline systolic BP <130 mmHg. Fixed-effect one-stage individual participant data (IPD) meta-analyses were used, and cox proportional hazard models, stratified by trial, were applied to analyse the data.
Results: Among 358,325 participants, 15,845 (4.4%) had IDH. For 4.2 years median follow-up, a 5 mm Hg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with IDH (hazard ratio 0.91; 95% CI, 0.82-1.01) and those without IDH (0.90; 95% CI, 0.89-0.92; P for interaction =1.00). Analyses by baseline diastolic BP showed no evidence of heterogeneity in treatment effects among individuals with baseline systolic BP < 130 mm Hg (P for interaction=0.26). Relative treatment effects were not statistically different by CVD history, age, prior medication use and BP measurement methods.
Conclusions: The study found no evidence to suggest that pharmacological BP-lowering therapy in individuals with IDH is less or more effective than in those without IDH. Relative risk reductions also did not diminish in those with lower diastolic BP, down to < 60 mmHg at baseline. No meaningful differences across various clinical phenotypes were detected.

Authors: Bidel, Z; Nazarzadeh, M; Canoy, D; McEvoy, JW; Maimaitiaili, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: European Heart Journal
• Article number: ehaf962
• Publication date: 2025-12-12
• Acceptance date: 2025-11-05
• DOI: 10.1093/eurheartj/ehaf962
• EISSN: 1522-9645
• ISSN: 0195-668X
• Language: English
• Keywords: individual participant-level data; major cardiovascular diseases; isolated diastolic hypertension; blood pressure-lowering treatment