| Summary: | Although brachial systolic blood pressure (SBP) is the overall best predictor of future cardiovascular risk for the entire hypertensive population, there is much that can be learned from assessing diastolic blood pressure (DBP) in relation to simultaneous levels of SBP, because the former is not distorted by pressure amplification. In very young (mean age of 20 years) hypertensives, discordantly low DBP, defined as isolated systolic hypertension (ISH), was associated with increased stroke volumes (SV), increased aortic stiffness or a combination of both. These individuals had a significantly higher mean central SBP than normotensive persons, and therefore, should not be classified as having spurious hypertension. In contrast, young adults with essential hypertension presented with elevated DBP and evidence of increased peripheral vascular resistance. Discordantly high DBP in young adults (mean age of 40 years) with isolated diastolic hypertension (IDH) was associated with a high prevalence of obesity and the metabolic syndrome; DBP was discordantly high because of a limited rise in SBP secondary to decreased pressure amplification. Discordantly very low DBP in the older age population (mean age ⩾60 years) with ISH defines a population with LVH, increased ventricular-arterial stiffness, and a propensity for diastolic dysfunction. Therefore, discordantly low DBP may be an early marker of increased SV and/or arterial stiffness in young adults and a late marker of ventricular-arterial stiffness in older adults. In contrast to risk prediction where brachial DBP may be of paramount importance, the therapeutic benefit of antihypertensive therapy is entirely related to decreased SBP.
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