Supplemental Digital Content is available in the text. The 2017 American College of Cardiology/American Heart Association guideline defines hypertension as a blood pressure ≥130/80 mm Hg, whereas the 2018 European Society of Cardiology (ESC) and 2019 National Institute for Health and Care Excellence (NICE) guidelines use a ≥140/90 mm Hg threshold. Our objective was to study the associations between isolated diastolic hypertension (IDH), diagnosed using these 2 blood pressure thresholds, and cardiovascular disease (CVD) in a large cohort of UK adults. We analyzed data from UK Biobank, which enrolled participants between 2006 and 2010 with follow-up through March 2019. We excluded persons with systolic hypertension or baseline CVD. We defined incident CVD as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. We used Cox regression to quantify associations between IDH and CVD, as well as the individual outcomes included in the composite outcome. We studied 151 831 participants with normal systolic blood pressure (mean age 54 years, 40% male). Overall, 24.5% had IDH by the American College of Cardiology/American Heart Association definition compared with 6% by the ESC/NICE definition. Compared with normal diastolic blood pressure, IDH by the American College of Cardiology/American Heart Association definition was not significantly associated with CVD risk (hazard ratio, 1.08 [95% CI, 0.98–1.18]) whereas IDH by the ESC/NICE definition was significantly associated with a modest increase in CVD (hazard ratio, 1.15 [95% CI, 1.04–1.29]). Similar results were found by sex and among participants not taking baseline antihypertensives. Furthermore, neither IDH definition was associated with the individual outcomes of nonfatal myocardial infarction or stroke. In conclusion, the proportion of UK Biobank participants with IDH was significantly higher by the American College of Cardiology/American Heart Association definition compared with the ESC/NICE definitions; however, only the ESC/NICE definition was statistically associated with increased CVD risk.

中文翻译：

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英国生物库中孤立的舒张期高血压

补充数字内容在文本中可用。2017 年美国心脏病学会/美国心脏协会指南将高血压定义为血压≥130/80 mmHg，而 2018 年欧洲心脏病学会 (ESC) 和 2019 年美国国家健康与护理卓越研究所 (NICE) 指南使用≥ 140/90 毫米汞柱阈值。我们的目标是在一大群英国成年人中研究使用这 2 个血压阈值诊断的孤立性舒张期高血压 (IDH) 与心血管疾病 (CVD) 之间的关联。我们分析了来自 UK Biobank 的数据，该银行在 2006 年至 2010 年间招募了参与者，随访至 2019 年 3 月。我们排除了患有收缩期高血压或基线 CVD 的人。我们将事件 CVD 定义为非致死性心肌梗死、非致死性卒中或心血管死亡的复合。我们使用 Cox 回归来量化 IDH 和 CVD 之间的关联，以及包含在复合结果中的个体结果。我们研究了 151 831 名收缩压正常的参与者（平均年龄 54 岁，40% 为男性）。总体而言，美国心脏病学会/美国心脏协会定义的 IDH 为 24.5%，而 ESC/NICE 的定义为 6%。与正常舒张压相比，美国心脏病学会/美国心脏协会定义的 IDH 与 CVD 风险没有显着相关性（风险比，1.08 [95% CI，0.98-1.18]），而 ESC/NICE 定义的 IDH与 CVD 的适度增加显着相关（风险比，1.15 [95% CI，1.04–1.29]）。性别和未服用基线抗高血压药物的参与者也发现了类似的结果。此外，IDH 的定义与非致死性心肌梗死或中风的个体结果无关。总之，与 ESC/NICE 定义相比，美国心脏病学会/美国心脏协会定义的英国生物银行 IDH 参与者比例显着更高；然而，只有 ESC/NICE 定义在统计学上与 CVD 风险增加相关。