Isolated diastolic hypertension and incident cardio-renal-metabolic multimorbidity in the Tehran Lipid and Glucose Study: comparison of ACC/AHA and ESC/NICE guideline definitions.

Hypertension is defined as ≥130/80 mm Hg by ACC/AHA 2017, and ≥140/90 mm Hg by the ESC 2018 and NICE 2019. We examined the association between isolated diastolic hypertension (IDH, by both thresholds) and cardio-renal-metabolic (CRM) multimorbidity. From 1999 to 2018, we followed 7377 (mean age: 37.7 years) and 6717 (36.8 years) Tehran Lipid and Glucose Study (TLGS) participants, initially free of cardiovascular disease (CVD), type 2 diabetes (T2DM), and chronic kidney disease, with systolic blood pressure (SBP) <140 and <130 mm Hg based on ESC/NICE and ACC/AHA criteria, respectively. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRM multimorbidity (coexistence of ≥2 of CVD, kidney function decline [KFD], and T2DM). IDH was identified in 28.2% of participants using ACC/AHA criteria and 5.9% using ESC/NICE criteria. Over a median 15.3-year follow-up (IQR: 12.1-16.6), 182 CRM multimorbidity events occurred per ACC/AHA IDH criteria and 241 per ESC/NICE criteria. In the fully adjusted model, IDH by ESC/NICE criteria was not significantly associated with CRM multimorbidity (HR: 1.45 [95% CI: 0.98-2.15]), while stage 2 IDH by ACC/AHA criteria showed a significant association (2.15 [1.21-3.82]). Similar associations of IDH with incident CRM multimorbidity were observed across age groups, sex, current smoking, obesity, dyslipidemia, and prediabetes. IDH was associated with increased risks of T2DM, CVD, and KFD as individual outcomes. In conclusion, stage 2 IDH per ACC/AHA criteria is linked to a higher risk of incident CRM multimorbidity, independent of SBP levels.