AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Isolated Diastolic Hypertension in the Presence of Metabolic Dysfunction: A Higher-Risk Phenotype?
By Le T, Koneru D, LE T et al.
Background: Prior studies have found no significant association between Isolated diastolic hypertension (IDH) alone and incident cardiovascular or chronic kidney disease outcomes, suggesting that IDH in isolation may represent a relatively benign hemodynamic phenotype. IDH frequently coexists with metabolic dysfunction (MetD), yet the combined impact of these phenotypes on cardiorenal risk and long-term mortality remains unknown. Hypothesis: DH accompanied by MetD represents a distinct, higher-risk cardiorenal phenotype. Methods: We analyzed data from 28,901 adults aged 20-79 years in the National Health and Nutrition Examination Survey (NHANES) 1999-2018, linked to the National Death Index through December 31, 2019. Participants were classified as Normal BP/No MetD (reference), Normal BP/MetD, IDH only, or IDH+MetD. Survey-weighted multivariable logistic regression examined associations with albuminuria (UACR ≥30 mg/g), reduced eGFR (<60 mL/min/1.73m ² ), and elevated hs-CRP (>3 mg/L; NHANES 1999-2010). Survey-weighted Cox proportional hazards regression assessed all-cause and cardiovascular mortality. Models were adjusted for demographic, socioeconomic, and clinical factors. Results: IDH was present in 13.2% of US adults, of whom 45.4% had co-occurring metabolic dysfunction (IDH+MetD), representing approximately 6.0% of the total adult population. The IDH+MetD phenotype was predominantly observed in younger males (mean age 44.9 years; 58.5% male), with a metabolic burden comparable to that of the Normal BP/MetD group. The weighted prevalence of Normal BP/No MetD, Normal BP/MetD, IDH only, and IDH+MetD was 55.5%, 31.3%, 7.2%, and 6.0%, respectively. Compared with Normal BP/No MetD, IDH+MetD was significantly associated with albuminuria (OR 1.51, 95% CI 1.17-1.94) and elevated hs-CRP (OR 1.50, 95% CI 1.26-1.79), while IDH only showed no significant associations with any subclinical risk marker. In sensitivity analyses using IDH only as the reference, IDH+MetD retained significantly higher odds of albuminuria (OR 1.47, 95% CI 1.05-2.04) and elevated hs-CRP (OR 1.61, 95% CI 1.26-2.06), confirming the incremental risk attributable to MetD within the IDH phenotype. IDH+MetD showed a non-significant trend toward increased cardiovascular mortality (HR 1.32, 95% CI 0.87-2.02), while all-cause mortality did not differ significantly across groups. No significant effect modification by sex was detected for the IDH+MetD phenotype across any outcome (all interaction p >0.05). Conclusions: Among adults with IDH, coexisting MetD identifies a higher-risk cardiorenal phenotype characterized by increased albuminuria and systemic inflammation. These findings support integrated blood pressure-metabolic phenotyping and suggest metabolic screening may improve risk stratification in individuals with IDH.