Isolated Diastolic Hypertension

Isolated diastolic hypertension is a type of high blood pressure in which only your diastolic (bottom) number is high. With this condition, your bottom number is in the hypertensive range of 80 millimeters of mercury (mmHg) or higher, but your systolic (top) number is lower than 130 mmHg. A normal blood pressure reading is lower than 120 mmHg (top number) and lower than 80 mmHg (bottom number).

This condition affects about 6 in 100 people in the U.S. Of all adults diagnosed with high blood pressure, about 1 in 5 have isolated diastolic hypertension. It typically affects people younger than 55. This is because as you get older, your diastolic blood pressure naturally goes down, while your systolic blood pressure goes up.

Isolated diastolic hypertension usually isn’t a serious issue right away. But it may raise your risk of cardiovascular (heart and blood vessel) problems down the road. Your healthcare provider will work with you to manage this condition.

Symptoms of isolated diastolic hypertension

Most people with this condition don’t have any symptoms. This is true for most other forms of high blood pressure, too. But if your diastolic number rises very high — 120 or higher — you may have anxiety, a mild headache, nosebleeds or shortness of breath. These symptoms can also occur if your systolic number is 180 or higher.

You may not realize the link between your blood pressure and what you’re feeling unless you use a home monitor to check your blood pressure. Tell your healthcare provider about any spikes or changes in your blood pressure right away.

Call 911 or your local emergency number if your diastolic blood pressure is 120 or higher and you have any of these symptoms:

• Chest pain or discomfort
• Confusion or changes to your thinking
• Dizziness
• Edema (swelling)
• Heart palpitations (funny heartbeats or racing heart)
• Peeing less than usual
• Seizures
• Severe headache
• Vision changes

These are signs of a hypertensive emergency. It means dangerously high blood pressure is damaging your organs. You need medical help immediately.

Causes of isolated diastolic hypertension

Experts don’t fully understand what causes your diastolic blood pressure to be high while your systolic blood pressure is normal. But having overweight/obesity, having sleep apnea and smoking are three of the biggest risk factors, according to some research.

Complications of this condition

Isolated diastolic hypertension may not cause immediate issues. But it raises your risk of a heart attack at some point during your life. It also makes you more likely to die from any type of cardiovascular disease. In addition, it increases your risk of congestive heart failure. These risks are greatest for females and those under age 60.

How doctors diagnose this condition

Your healthcare provider will do a physical exam and measure your blood pressure. They’ll diagnose you with isolated diastolic hypertension if the bottom number is 80 or higher at two or more office visits (while the top number is normal).

Your provider may also recommend ambulatory blood pressure monitoring. This means you wear a device that checks your blood pressure for 24 hours. It can help your provider see if your office readings are accurate. It also helps to see whether your symptoms are related to elevations in your blood pressure.

How is isolated diastolic hypertension treated?

Treatment depends on your age and other risk factors for heart disease. Many people with isolated diastolic hypertension don’t need medicine — at least not right away. Instead, your provider will talk to you about changes you can make in your daily life that may help lower your blood pressure. These include:

• Following a Mediterranean diet or DASH diet
• Maintaining a weight that’s healthy for you
• Getting at least 150 minutes of aerobic exercise per week
• Quitting smoking
• Limiting or avoiding alcohol

Your provider will check your blood pressure on a regular basis. They may recommend antihypertensive medicine if your diastolic blood pressure stays too high or you develop high systolic blood pressure, too.

You may need to start taking medicine sooner if you have:

• Diabetes
• Chronic kidney disease (CKD)
• A cardiovascular disease diagnosis
• An elevated risk of cardiovascular disease in the next 10 years

When should I see my healthcare provider?

See a healthcare provider for an annual physical. This gives you the chance to learn your blood pressure numbers. You may need follow-up visits based on these results.

If you have isolated diastolic hypertension, your provider will let you know how often to come in for blood pressure checks.

What can I expect if I have this condition?

You’ll work with your healthcare provider to manage isolated diastolic hypertension. Your provider may ask you to check your blood pressure at home and keep a log of the readings. This can help them see what your numbers look like when you’re going about your usual activities.

Be sure to use a validated device to get the most precise readings. Avoid using cuffless devices or smartwatches to measure your blood pressure. Those typically won’t give you readings that are accurate enough. The best devices are validated ones that go around your upper arm, above the elbow.