Impact of transiently elevated diastolic pressure on cause of death: 29-year follow-up from the General Practice Hypertension Study Group

Objectives: High blood pressure is known to be associated with higher cardiovascular risk. The emphasis has shifted over time from diastolic pressure to systolic pressure and variability in blood pressure. This study examined the impact of transient and sustained diastolic hypertension on later mortality. Methods: In the early 1970s, the General Practice Hypertension Study Group screened more than 20 000 patients and selected those with diastolic hypertension, with a transiently elevated diastolic pressure and age-matched and sex-matched normotensive controls to be flagged for long-term death certificate follow-up. After a mean follow-up of 29 years, Cox proportional hazard regression was used to examine the relationship between diastolic hypertension and cause of death. Results: Overall those with diastolic hypertension and transient diastolic hypertension were at increased risk of total and cardiovascular mortality. When men and women were examined separately, however, the relationships remained significant in women only, with transient diastolic hypertension showing the strongest association with cardiovascular and total mortality: hazard ratio 1.57 [95% confidence interval (CI) 1.11-2.23] and hazard ratio 1.39 (95% CI 1.10-1.76), respectively. Conclusion: Transient diastolic hypertension does not seem to be benign, particularly in women and may point to those at higher cardiovascular risk when seen in a general practice population.