Li Y, Wei FF, Wang S, Cheng YB, Wang JG.

Cardiovascular risks associated with diastolic

blood pressure and isolated diastolic hypertension. Curr Hypertens Rep. 2014 Nov;16(11):489.
Abstract
Hypertension is a major reversible risk factor for cardiovascular complications. According to
recent guidelines, hypertension can be subdivided into isolated diastolic, isolated systolic, and
systolic and diastolic mixed hypertension using proposed thresholds of various blood pressure
components. In the present article, we reviewed the association of cardiovascular outcomes with
diastolic blood pressure versus systolic blood pressure and with isolated diastolic hypertension
versus systolic and mixed hypertension in observational prospective cohort studies and large-scale
individual data-based meta-analysis. Blood pressure was measured either in the clinic or at home
or under ambulatory conditions for 24 h in cohort studies. To illustrate the treatment effect of
diastolic blood pressure lowering, we also reviewed randomized placebo-controlled outcome trials
in diastolic hypertension.
CONCLUSIONS:
The risks conferred by diastolic and systolic blood pressure, irrespective of the methods of blood
pressure measurement, are age-dependent. Diastolic blood pressure and isolated diastolic
hypertension drive coronary risk in younger subjects, whereas systolic blood pressure is the
predominant risk indicator in older people. Reversibility of the risk by diastolic BP lowering
treatment in randomized trials confirms that diastolic hypertension is a risk factor that must be
treated.
Risiko tekanan darah sistolik dan diastolic tergantung umur. Tekanan darah diastolik dan isolated
diastolik hipertensi pada kelompok umur yang lebih muda , sedangkan tekanan darah sistolik pada
umur yang lebih tua.

Adeoye AM, Adebiyi A, Bamidele O. Tayo BO et al. Hypertension Subtypes among Hypertensive
Patients in Ibadan. International Journal of Hypertension Volume 2014. Article ID 295916.
Identifikasi hipertensi mempergunakan definisi JNC VII yang membagi 4 subtipe: controlled
hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH),
and systolic-diastolic hypertension (SDH). Dibandingkan dengan kelompok kontrol, kasus SDH
merupakan kasus terbanyak yang ditemukan. Pada kelompok gender wanita, SDH (77.6% vs
73%) dan IDH (4.9% vs 4.7%) sedangkan pada kelompok pria lebih banyak ISH (10.1% vs 6.2%
). Wanita lebih banyak yang menderita obesitas dan SDH lebih banyak pada kelompok obesitas.

Wang Y, Xing F, Liu R, Liu L, Zhu Y. Isolated Diastolic Hypertension Associated Risk Factors
among Chinese in Anhui Province, China. Int J Environ Res Public Health. 2015 Apr; 12(4): 4395–
4405.
Objective: To explore potential risk factors of isolated diastolic hypertension (IDH) among young
and middle-aged Chinese. Methods: A community-based cross-sectional study was conducted
among 338 subjects, aged 25 years and above, using random sampling technique. There were 68
cases of IDH, 46 cases of isolated systolic hypertension (ISH), 89 cases of systolic and diastolic
hypertension (SDH), and 135 of subjects with normal blood pressure. Cases and controls were
matched on sex by frequency matching. Demographic characteristics, blood pressure and other
relevant information were collected.Results: Compared with controls, patients with IDH and ISH
had significant higher level of triglyceride, high density lipoprotein, blood glucose and body mass
index (BMI) (p < 0.05); while patients with SDH had significantly higher level of total cholesterol,
triglyceride, glucose and BMI (p < 0.05). Linear mixed effects model showed that drinking tea,
family history of hypertension (FHH), higher blood glucose, triglyceride and low density
lipoprotein were related with elevated diastolic blood pressure (DBP) (p < 0.01); HFH, blood
glucose, creatinine and BMI have positive effect on systolic blood pressure (SBP) (p < 0.05).
Conclusions: Drinking tea, FHH, high levels of triglyceride, high density lipoprotein, blood
glucose and BMI are associated with IDH among young and middle-aged Chinese.
Penelitian cross sectional di China dengan 338 responden berumur mulai 25 tahun ditemukan 68
kasus IDH (20.11%), 46 kasus ISH (13.61%), 89 kasus SDH (26.34%) dan 135 responden
dengan tekanan darah normal (39.94%). IDH, ISH dan SDH mempunyai korelasi yang signifikan
dengan BMI. Riwayat keluarga dengan hipertensi berkorelasi dengan peningkatan DBP secara
signifikan sedangkan Riwayat keluarga dengan hipertensi dan BMI mempunyai efek positif
dengan SBP secara signifikan.

1. Pickering T.G. Isolated diastolic hypertension. J. Clin. Hypertens. 2003;5:411–413. doi:

10.1111/j.1524-6175.2003.02840.x. [PubMed] [Cross Ref]
2. Midha T., Lalchandani A., Nath B., Kumari R., Pandey U. Prevalence of isolated diastolic
hypertension and associated risk factors among adults in Kanpur, India. Indian Heart
J. 2012;64:374–379. doi: 10.1016/j.ihj.2012.06.007. [PMC free article] [PubMed] [Cross Ref]
3. Hozawa A., Ohkubo T., Nagai K., Kikuya M., Matsubara M., Tsuji I., Ito S., Satoh H.,
Hisamichi S., Imai Y. Prognosis of isolated systolic and isolated diastolic hypertension as
assessed by self-measurement of blood pressure at home: The ohasama study. Arch. Intern.
Med. 2000;160:3301–3306. doi: 10.1001/archinte.160.21.3301. [PubMed] [Cross Ref]
4. Niiranen T.J., Rissanen H., Johansson J.K., Jula A.M. Overall cardiovascular prognosis of
isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with
home measurements: The Finn-home study. J. Hypertension. 2014;32:518–524. doi:
10.1097/HJH.0000000000000070.[PubMed] [Cross Ref]
5. Li Y., Wei F.F., Wang S., Cheng Y.B., Wang J.G. Cardiovascular risks associated with
diastolic blood pressure and isolated diastolic hypertension. Curr. Hypertens. Rep. 2014 doi:
10.1007/s11906-014-0489-x.[PubMed] [Cross Ref]
6. Franklin S.S., Pio J.R., Wong N.D., Larson M.G., Leip E.P., Vasan R.S., Levy D. Predictors
of new-onset diastolic and systolic hypertension: The Framingham Heart Study. Circ.
J. 2005;111:1121–1127. doi: 10.1161/01.CIR.0000157159.39889.EC. [PubMed] [Cross Ref]
7. Yano Y., Stamler J., Garside D.B., Daviglus M.L., Franklin S.S., Carnethon M.R., Liu K.,
Greenland P., Lloyd-Jones D.M. Isolated systolic hypertension in young and middle-aged adults
and 31-year risk for cardiovascular mortality: The Chicago heart association detection project in
industry study. J. Amer. Coll. Cardiol. 2015;65:327–335. doi: 10.1016/j.jacc.2014.10.060. [PMC
free article] [PubMed] [Cross Ref]
8. Yeh C.J., Pan W.H., Jong Y.S., Kuo Y.Y., Lo C.H. Incidence and predictors of isolated
systolic hypertension and isolated diastolic hypertension in Taiwan. J. Formos. Med.
Assoc. 2001;100:668–675.[PubMed]
9. Adeoye A.M., Adebiyi A., Tayo B.O., Salako B.L., Ogunniyi A., Cooper R.S. Hypertension
subtypes among hypertensive patients in Ibadan. Int. J. Hypertens. 2014 doi:
10.1155/2014/295916.[PMC free article] [PubMed] [Cross Ref]
10. Wu H

Midha T, Lalchandani A, Nath B, Kumari R, Pandey U. Prevalence of isolated diastolic

hypertension and associated risk factors among adults in Kanpur, India. Indian Heart J. 2012 Jul;
64(4): 374–379.

Results
The prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant
proportion of IDH was seen in the 40–49 years age group. Multivariate logistic regression
analysis of the associated risk factors showed that gender, physical activity and BMI were
significantly associated with IDH.
Globally 26.4% of the adult population in 2000 had hypertension and 29.2% were projected to
have this condition by 2025.1 Worldwide, 7.1 million deaths (approximately 12.8% of the global
total) and 64.3 million Disability Adjusted Life Years (DALYs) (4.4% of the global total), were
estimated to be due to non-optimal blood pressure and approximately two-thirds of the
attributable burden of disease occurred in the developing world.2 The World Health
Organization (WHO) has estimated that globally hypertension is directly responsible for about
62% of cerebrovascular disease and 49% of ischemic heart disease.2
The risks of stroke and coronary heart disease (CHD) are directly related to both the levels of
systolic blood pressure (SBP) and diastolic blood pressure (DBP).3 The argument concerning the
relative importance of SBP and DBP is not new. While isolated systolic hypertension (ISH) has
been identified as a specific clinical entity, isolated diastolic hypertension (IDH) has not been
reported as a separate group. IDH was defined as diastolic BP more than 90 mmHg and systolic
BP less than 140 mmHg.
According to the Framingham Heart Study, in younger adults, IDH is more common than systo-
diastolic hypertension (SDH).4 The Third National Health and Nutrition Examination Survey
(NHANES III, 1988–1991) showed that IDH was the most frequent form of diastolic
hypertension in young adults <40 years old and comparable to SDH in prevalence from age 40–
49 years.5 Together, IDH and SDH accounted for more than 75% of younger adult individuals
with untreated hypertension.
According to the Framingham report, subjects with IDH were more frequently men and smokers
and their mean body mass index (BMI) was higher than their normotensive counterparts. It has
recommended that the subjects with IDH, although possibly not at increased risk in the short or
middle term should be carefully monitored over time.6–9 The recommendation is that in these
patients, the goal of treatment should be the control of all cardiovascular risk factors, not solely
the BP normalization.
IDH is a largely under-rated risk factor for cardiovascular mortality, nevertheless its prevalence
in the younger age group, its concurrence with other cardiovascular risk factors and above all
paucity of data regarding IDH in developing countries necessitate that it should be investigated.
Therefore, the present study was planned with the objective to determine the prevalence of IDH
in the adult population of Kanpur district and to identify the associated risk factors of IDH.
Penelitian di India menyatakan bahwa prevalensi IDH adalah 4.5%. Proporsi yang signifikan
pada kelompok umur 40-49 tahun. Gender, aktifitas fisik dan BMI berhubungan dengan IDH
secara signifikan. Secara global diperkirakan penderita hipertensi mencapai 29.2% pada thaun
2025.1 Di seluruh dunia, 7 juta kematian (12.8% dari kematian secara keseluruhan) adalah akibat
tekanan darah yang tidak optimal dan 2/3 terjadi di negara sedang berkembang.2 WHO
memperkirakan bahwa hipertensi bertanggungjawab secara langsung terhadap 62% CVD dan
49% penyakit jantung iskemik.2 Sedangkan risiko stroke dan CHD secara langsung terkait
dengan SBP dan DBP.3 IDH didefinisikan sebagai tekanan darah diastolik lebih dari 90 mmHg
dan sistolik kurang dari 140 mmHg.

Menurut Framingham Heart Study, pada kelompok dewasa muda, IDH lebih sering ditemukan
daripada SDH.4 The Third National Health and Nutrition Examination Survey (NHANES III)
memperlihatkan bahwa IDH adalah bentuk hipertensi diastolik yang paling sering ditemukan pada
keloimpok umur <40 tahun, sedangkan SDH pada kelompok umur 40-49 tahun.5 Menurut
Framingham Heart Study, subjek dengan IDH lebih sering ditemukan pada pria dan BMI yang
lebih tinggi dari subjek dengan normotensi. IDH merupakan risiko tinggi terhadap kematian CVD

References
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2. World Health Report . 2002. Reducing Risks, Promoting Healthy
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Cardiovasc Dis. 1974;27:5. [PubMed]
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– the Framingham heart study. Circulation. 2005;111:1121–1127. [PubMed]
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systolic hypertension among middle-aged and elderly US hypertensives: analysis based on
National Health and Nutrition Examination Survey (NHANES III) Hypertension. 2001;37:869–
874. [PubMed]
6. Fang J., Mafhavan S., Cohen H., Alderman M.H. Isolated diastolic hypertension: a favourable
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8. Nielsen W.B., Lindenstrom E., Vestbo J., Jensen G.B. Is diastolic hypertension an
independent risk factor for stroke in the presence of normal systolic blood pressure in the
middle-aged and elderly? Am J Hypertens. 1997;10:634–639. [PubMed]
9. Strandberg T.E., Saloman V.V., Vanhanen H.T., Pitkala K., Miettinen T.A. Isolated diastolic
hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a
follow-up of up to 32 years. J Hypertens. 2002;20:399–404. [PubMed]

Niiranen T J; Rissanen H; Johansson J K; Jula A M. Overall cardiovascular prognosis of isolated

systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home
measurements: the Finn-home study. Journal of Hypertension. 32(3):518–524, MAR 2014
Methods: A prospective nationwide study was initiated in 2000–2001 on 1924 randomly selected
participants aged 44–74 years. We determined home and office BP at baseline and classified the
individuals into four groups according to their home BP levels: normotension, isolated diastolic
hypertension, isolated systolic hypertensionand systolic–diastolic hypertension. The primary
endpoint was incidence of a composite cardiovascular event.
Results: After a median follow-up of 11.2 years, 236 individuals had suffered a cardiovascular
event. In multivariable Cox proportional hazard models, the relative hazards and 95% confidence
intervals (CIs) for cardiovascular events were significantly higher in participants with isolated
diastolic hypertension (relative hazard 1.95; 95% CI, 1.06–3.57; P = 0.03), isolated systolic
hypertension (relative hazard 2.08; 95% CI, 1.42–3.05; P < 0.001) and systolic–diastolic
hypertension (relative hazard 2.79; 95% CI, 2.02–3.86; P < 0.001) than in participants with
normotension. Home (relative hazard 1.21; 95% CI, 1.05–1.40; P = 0.009 per 10 mmHg increase),
but not office (relative hazard 1.10; 95% CI, 1.00–1.21, P = 0.06) pulse pressure, adjusted for mean
arterial pressure, was an independent predictor of cardiovascular risk.
Conclusion: Isolated diastolic and systolic hypertension defined with home measurements are
associated with an increased cardiovascular risk. Close follow-up and possible treatment of these
patients is therefore warranted. Home-measured pulse pressure is an independent predictor of
cardiovascular events while office-measured pulse pressure is not, which fortifies the view that
home BP provides more accurate risk prediction than office BP.
Penelitian prospektif melibatkan 1924 partisipan berumur 44-74 tahun ditemukan bahwa 236
individu menderita CVD yang secara signifikan lebih tinggi pada IDH, ISH dan SDH
dibandingkan dengan normotensi.

Yano Y, Stamler J, Garside DB, Daviglus ML, Franklin SS. et al. Isolated Systolic Hypertension
in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality: The Chicago
Heart Association Detection Project in Industry Study. Journal of the American College of
Cardiology. Volume 65, Issue 4, 3 February 2015, Pages 327-335
Isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg
and diastolic blood pressure (DBP) <90 mm Hg, in younger and middle-aged adults is increasing
in prevalence.
Objective
The aim of this study was to assess the risk for cardiovascular disease (CVD) with ISH in younger
and middle-aged adults.
Methods
CVD risks were explored in 15,868 men and 11,213 women 18 to 49 years of age (mean age 34
years) at baseline, 85% non-Hispanic white, free of coronary heart disease (CHD)
and antihypertensive therapy, from the Chicago Heart Association Detection Project in Industry
study. Participant classifications were as follows: 1) optimal-normal blood pressure (BP)
(SBP <130 mm Hg and DBP <85 mm Hg); 2) high-normal BP (130 to 139/85 to 89 mm Hg); 3)
ISH; 4) isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg); and 5) systolic
diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg).
Results
During a 31-year average follow-up period (842,600 person-years), there were 1,728 deaths from
CVD, 1,168 from CHD, and 223 from stroke. Cox proportional hazards models were adjusted for
age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men,
with optimal-normal BP as the reference stratum, hazard ratios for CVD and CHD mortality risk
for those with ISH were 1.23 (95% confidence interval [CI]: 1.03 to 1.46) and 1.28 (95% CI: 1.04
to 1.58), respectively. ISH risks were similar to those with high-normal BP and less than those
associated with isolated diastolic hypertension and systolic diastolic hypertension. In women with
ISH, hazard ratios for CVD and CHD mortality risk were 1.55 (95% CI: 1.18 to 2.05) and 2.12
(95% CI: 1.49 to 3.01), respectively. ISH risks were higher than in those with high-normal BP or
isolated diastolic hypertension and less than those associated with systolic diastolic hypertension.
Conclusions
Over long-term follow-up, younger and middle-aged adults with ISH had higher relative risk for
CVD and CHD mortality than those with optimal-normal BP.
ISH didefinisikan sebagai SBP ≥140 mm Hg dan DBP <90 mm Hg. Dilakukan penelitian terhadap
15,868 peserta pria dan 11,213 peserta wanita dengan kisaran umur 18-49 tahun. Dalam penelitian
ini the Chicago Heart Association Detection Project in Industry membagi partisipan menjadi 5
kategori masing-masing: 1) Tekanan darah optimal-normal (SBP <130mm Hg dan DBP <85 mm
Hg); 2) Tekanan darah normal-tinggi (130-139/85-89 mm Hg); 3) ISH; 4) IDH; 5) SDH. Setelah
penelitian berlangsung selama 31 tahun ditemukan 1,728 kematian dengan CVD, 1,168 dengan
CHD dan 223 dengan stroke. Pada kelompok pria dengan ISH, dengan merujuk kategori 1, risiko
kematian ISH akibat CVD dan CHD masing-masing 1.23 (95% CI: 1.03-1.46) dan 1.28 (95% CI:
1.04-1.58). Sedangkan pada kelompok wanita dengan ISH risiko kematian akibat CVD dan CHD
adalah 1.55 (95% CI: 1.18-2.05) dan 2.12 (95% CI: 1.49-3.01). Pada kelompok penelitian ini,
risiko ISH lebih tinggi dibandingkan dengan kategori 2 dan IDH. Pada kelompok muda-dewasa
dengan ISH (kategori 3), risiko kematian akibat CVD dan CHD lebih tinggi dibandingkan dengan
kelompok Tekanan darah optimal-normal (kategori 1).

Adeoye AM, Adebiyi A, Bamidele O. Tayo BO et al. Hypertension Subtypes among Hypertensive
Patients in Ibadan. International Journal of Hypertension Volume 2014. Article ID 295916.
Background. Certain hypertension subtypes have been shown to increase the risk for
cardiovascular morbidity and mortality and may be related to specific underlying genetic
determinants. Inappropriate characterization of subtypes of hypertension makes efforts at
elucidating the genetic contributions to the etiology of hypertension largely vapid. We report the
hypertension subtypes among patients with hypertension from South-Western
Nigeria. Methods. A total of 1858 subjects comprising 76% female, hypertensive, aged 18 and
above were recruited into the study from two centers in Ibadan, Nigeria. Hypertension was
identified using JNCVII definition and was further grouped into four subtypes: controlled
hypertension (CH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH),
and systolic-diastolic hypertension (SDH). Results.Systolic-diastolic hypertension was the most
prevalent. Whereas SDH (77.6% versus 73.5%) and IDH (4.9% versus 4.7%) were more prevalent
among females, ISH (10.1% versus 6.2%) was higher among males . Female subjects were more
obese and SDH was prevalent among the obese group. Conclusion. Gender and obesity
significantly influenced the distribution of the hypertension subtypes. Characterization of
hypertension by subtypes in genetic association studies could lead to identification of previously
unknown genetic variants involved in the etiology of hypertension. Large-scale studies among
various ethnic groups may be needed to confirm these observations.
Penelitian hipertensi di Ibadan-Nigeria memperlihatkan peningkatan morbiditas dan mortalitas
CVD terkait dengan genetic sebagai determinan. Sampel penelitian berjumlah 1,858 yang terdiri
dari 76% wanita berumur 18 tahun ke atas. Identifikasi hipertensi mempergunakan definisi JNC
VII yang membagi 4 subtipe: controlled hypertension (CH), isolated systolic hypertension (ISH),
isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). Dibandingkan
dengan kelompok kontrol, kasus SDH merupakan kasus terbanyak yang ditemukan. Pada
kelompok gender wanita, SDH (77.6% vs 73%) dan IDH (4.9% vs 4.7%) sedangkan pada
kelompok pria lebih banyak ISH (10.1% vs 6.2% ). Wanita lebih banyak yang menderita obesitas
dan SDH lebih banyak pada kelompok obesitas.

Cardiovascular disease is the world’s number one killer. World Heart Federation statistics reveal
that cardiovascular diseases account for 17.3 million deaths per year, and by 2030 this is expected
to rise to 23 million. Hypertension remains a worldwide phenomenon being a major component of
cardiovascular diseases with life-time cumulative incidence approaching 50% in many populations
[1]. Mass migration from rural to peri-urban and urban areas with improved industrialization and
adoption of western diets and lifestyle changes have led to steady increase in incidence of
hypertension in Africa [2, 3]. In sub-Sahara alone, about 10–20 million people have hypertension
with various degrees of target organ damages [4]. Based on the data available, the African Union
has identified hypertension as one of its challenges after AIDS [3, 5].
In Nigeria, the prevalence of hypertension is on the increase among both the rural and urban settlers
with resultant rising trends of sudden cardiac death [6–9]. Currently about 36 million Nigerians
are estimated to have hypertension and its associated complications [9]. Despite all the advances
in the study and management of hypertension, the control remains very poor. Salako et al. [10]
found only 25.4% of subjects studied in a clinical setting had both systolic blood pressure (SBP)
and diastolic blood pressure (DBP) controlled. Uncontrolled hypertension accounts for substantial
proportion of cardiovascular deaths and morbidity resulting from stroke, heart failure, acute
myocardial infarction, and kidney failure [11–13]
Prevention of hypertension and its control can markedly reduce cardiovascular morbidity and
mortality; however the multifactorial aetiopathophysiologic mechanism of hypertension makes
control difficult. A complex relationship within the environment and genetics accounts for the
etiology of this disease. While the environmental factors such as obesity, diet (especially high
sodium, low potassium, and excess energy intake), stress, and physical inactivity are easily
elucidated, the genetic determinants of hypertension remain obscure. Heterogeneity within patient
subsets and attempts to combine all hypertensives together in the search of genes has made genetic
 study of hypertension highly challenging and mostly difficult. It is possible that hypertension is
due to multiple distinct genes that can be studied better by subdividing hypertensive subtypes and
this approach may help elucidate the genetics and pathophysiology of hypertension. The search
for homogeneous hypertension subtypes has in the recent years widened the scope of our
understanding of monogenic Mendelian hypertension [14]. It was shown that primary hypertension
with hypokalemia has different pathophysiologic mechanism than those without hypokalemia.
Also Jiménez et al. [15] described an association between predominantly diastolic hypertension
(PDH) subtypes and the angiotensin-converting enzyme DD polymorphism in a small population
of untreated patients with PDH. Most of the studies being undertaken to define the genetic
influences have been in western societies where high levels of exposure to environmental risk
factors prevail, especially obesity and excess sodium intake [16, 17]. To broaden the perspective
on the subtypes of this condition we report a case series of subjects with hypertension at the
University College Hospital and Adeoyo State Hospital Ibadan, Nigeria.
CVD merupakan pembunuh nomor satu di dunia. World Heart Federation menyatakan bahwa
CVD menyebabkan 17.3 juta kematian per tahun dan pada tahun 2030 diperkirakan akan
meningkat menjadi 23 juta. Hipertensi merupakan fenomena komponen utama CVD.1 Migrasi
massal dari desa ke pinggiran kota, industrialisasi, western diets dan perubahan gaya hidup telah
menyebabkan peningkatan kasus hipertensi.2,3 Di sub-Sahara, 10-20 juta jiwa menderita hipertensi
dengan berbagai derajat kerusakan target organ. African Union telah menyatakan hipertensi
sebagai salah satu tantangan setelah AIDS.3,5 Di Nigeria prevalensi hipertensi meningkat baik di
pedesaan maupun di perkotaan disertai dengan meningkatnya kematian jantung mendadak.6-9
Diperkirakan 36 juta masyarakat Nigeria menderita hipertensi yang disertai dengan komplikasi.9
Salako et al menemukan hanya 25.4% penderita SBP dan DBP yang melakukan control. Hipertensi
yang tidak terkontrol akan mengakibatkan kematian CVD dan morbiditas stroke, gagal jantung
dan infark miokardial akut serta gagal ginjal.11-13
Pencegahan dan control hipertensi dapat mengurangi morbiditas dan mortalitas CVD

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Prevalence, Risk Factors, Predictors and Treatment. Results of a National Survey. Balkan Med J.
2016 Jan; 33(1): 52–57.
Previous surveys in KSA reported a 5.3% prevalence of IDH more than two decades ago (4). Studies in
different countries reported a prevalence of IDH ranging from 2–8%, mostly associated with males,
younger adults, and obese individuals (19–24).
4. Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY, et al. Hypertension in Saudi
Arabia. Saudi Med J. 2007;28:77–84.
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hypertension and associated risk factors among adults in Kanpur, India. Indian Heart
J. 2012;64:374–9.
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Scheduled Caste community of the District Nadia, West Bengal, India. High Blood Press
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adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc
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This was a cross-sectional national community-based study covering the whole of the Kingdom of Saudi
Arabia in 2005. The study population were Saudi adults aged 15–64 years selected by a multistage
stratified cluster random sampling technique. Stratification was based on age, gender and health regions
of the country.
A total of 4758 subjects participated in the study; 4562 were included in the final analysis giving an overall
response rate of 95.9%. The overall prevalence of hypertension was 20.9% (951 patients). Table 1 profiles
the demographic characteristics along with the prevalence of IDH. Males constituted about 49% of the
study population. About a quarter of the subjects were in the age group 35–44 years, with primary care
education. The majority of employed subjects work as government employees. About one third of
subjects earn less than 3000 Saudi Riyals (800 US $). The prevalence of IDH was 3.95% (180 patients),
constituting 18.9% of all hypertensives and about half of them (89 patients) were not aware of their
disease; they discovered their illness for the first time during the survey. IDH was significantly associated
with age, gender and occupation. It was significantly higher among males, in the age group 35–44 years
and among government employees. IDH was not significantly associated with place, education or income.
IDH was significantly higher among smokers, but it was not related to physical activity and diet, as shown
in Table 2. Table 3
Penelitian ini adalah cross sectional berbasis komunitas yang mencakup seluruh Kerajaan Arab
Saudi pada tahun 2005. Populasi penelitian adalah orang dewasa Saudi yang berusia 15-64 tahun
yang dipilih dengan teknik multistage stratified cluster random sampling. Stratifikasi didasarkan
pada usia, jenis kelamin dan wilayah kesehatan negara.
Sebanyak 4758 subjek berpartisipasi dalam penelitian ini; 4562 dimasukkan dalam analisis akhir
memberikan tingkat respons keseluruhan 95,9%. Prevalensi keseluruhan hipertensi adalah 20,9%
(951 pasien). Tabel 1 profil karakteristik demografi bersama dengan prevalensi IDH. Laki-laki
merupakan sekitar 49% dari populasi penelitian. Sekitar seperempat dari subyek berada di
kelompok usia 35-44 tahun, dengan pendidikan perawatan primer. Mayoritas subjek yang
dipekerjakan bekerja sebagai pegawai pemerintah. Sekitar sepertiga dari subjek mendapatkan
kurang dari 3000 Riyal Saudi (800 US $). Prevalensi IDH adalah 3,95% (180 pasien), merupakan
18,9% dari semua hipertensi dan sekitar setengah dari mereka (89 pasien) tidak menyadari
penyakit mereka; mereka menemukan penyakit mereka untuk pertama kalinya selama survei. IDH
secara signifikan terkait dengan usia, jenis kelamin dan pekerjaan. Itu secara signifikan lebih tinggi
di antara laki-laki, dalam kelompok usia 35-44 tahun dan di antara pegawai pemerintah. IDH tidak
terkait secara signifikan dengan tempat, pendidikan atau penghasilan. IDH secara signifikan lebih
tinggi di kalangan perokok, tetapi itu tidak terkait dengan aktivitas fisik dan diet, seperti yang
ditunjukkan pada Tabel 2. Tabel 3

Penelitian ini adalah cross sectional berbasis komunitas yang mencakup seluruh Kerajaan Arab
Saudi. Populasi penelitian adalah orang dewasa Saudi yang berusia 15-64 tahun yang dipilih
dengan teknik multistage stratified cluster random sampling. Sebanyak 4,758 subjek berpartisipasi
dalam penelitian ini. Prevalensi keseluruhan hipertensi adalah 20,9% (951 pasien). Prevalensi IDH
adalah 3,95% (180 pasien), merupakan 18,9% dari semua hipertensi. IDH secara signifikan terkait
dengan usia, jenis kelamin dan pekerjaan. Itu secara signifikan lebih tinggi di antara laki-laki,
dalam kelompok usia 35-44 tahun dan di antara pegawai pemerintah. IDH tidak terkait secara
signifikan dengan tempat, pendidikan atau penghasilan. IDH secara signifikan lebih tinggi di
kalangan perokok, tetapi itu tidak terkait dengan aktivitas fisik dan diet

SBP appears to be a better predictor of events than DBP after the age of 50 years.23,26,27 High DBP is
associated with increased CV risk and is more commonly elevated in younger (<50 years) vs. older
patients. DBP tends to decline from midlife as a consequence of arterial stiffening; consequently,
SBP assumes even greater importance as a risk factor from midlife.26 In middle-aged and older
people, increased pulse pressure (the difference between SBP and DBP values) has additional
adverse prognostic significance.28,29
28 Domanski M, Mitchell G, Pfeffer M, Neaton JD, Norman J. Pulse pressure and cardiovascular
disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA
2002;287:2677–2683.
29 Franklin SS, Lopez VA, Wong ND, Mitchell GF, Larson MG. Single versus combined blood pressure
components and risk for cardiovascular disease: the Framingham Heart Study. Circulation
2009;119:243–250.