Diastolic Morning Surge Improves Risk Stratification for Subclinical Left Ventricular Diastolic Dysfunction in Ambulatory‐Defined Isolated Diastolic Hypertension

Jun 15, 2026Journal of clinical hypertension (Greenwich, Conn.)

Morning Rise in Heart Relaxation Pressure Helps Identify Hidden Heart Function Problems in People with Isolated High Diastolic Blood Pressure

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Abstract

In a study of 737 untreated adults, isolated diastolic hypertension (IDH) was independently associated with subclinical left ventricular diastolic dysfunction (LVDD) with an odds ratio of 2.79.

Sustained ambulatory diastolic load may contribute to early myocardial remodeling despite preserved systolic pressure.
Dynamic circadian variation, particularly the diastolic morning surge (DMS), could impose additional hemodynamic stress not captured by average blood pressure.
Incorporating DMS into risk assessments attenuated the association between IDH and LVDD but still provided valuable additional information.
DMS improved the ability to discriminate between individuals at risk for LVDD, enhancing overall predictive accuracy.
Ambulatory-defined IDH is linked with an increased risk of subclinical LVDD, emphasizing the importance of dynamic assessments in risk stratification.

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Isolated diastolic hypertension (IDH) is frequently considered a lower-risk phenotype due to preserved systolic pressure; however, sustained ambulatory diastolic load may promote early myocardial remodeling. Dynamic circadian variation, particularly diastolic morning surge (DMS), may impose additional hemodynamic stress not reflected by mean blood pressure values. We evaluated whether incorporation of DMS improves risk stratification for subclinical left ventricular diastolic dysfunction (LVDD) in ambulatory-defined IDH. In this cross-sectional study, 737 untreated adults undergoing standardized 24-h ambulatory blood pressure monitoring and echocardiography were analyzed (353 IDH; 384 normotensive controls). IDH was defined as 24-h mean diastolic blood pressure ≥80 mmHg with systolic pressure <130 mmHg, and LVDD was adjudicated using 2016 ASE/EACVI criteria. In adjusted analyses, IDH was independently associated with LVDD (OR 2.79, 95% CI 1.79-3.77). Addition of DMS attenuated but did not eliminate the IDH association and provided independent incremental information (OR 1.44 per 5 mmHg, 95% CI 1.09-1.90). Incorporation of DMS improved discrimination (AUC 0.76 to 0.81; p = 0.041), strengthened calibration, reduced overall prediction error, and provided greater net clinical benefit across intermediate risk thresholds. Ambulatory-defined IDH is strongly associated with subclinical LVDD, and assessment of dynamic diastolic load through DMS offers incremental information beyond mean ambulatory pressure values for model-based discrimination and phenotypic characterization of LVDD.

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Diastolic Morning Surge Improves Risk Stratification for Subclinical Left Ventricular Diastolic Dysfunction in Ambulatory‐Defined Isolated Diastolic Hypertension

Abstract

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