{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:18:39Z","timestamp":1783693119091,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Isolated diastolic hypertension (IDH) is frequently considered a lower\u2010risk 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\u2010defined IDH. In this cross\u2010sectional study, 737 untreated adults undergoing standardized 24\u2010h ambulatory blood pressure monitoring and echocardiography were analyzed (353 IDH; 384 normotensive controls). IDH was defined as 24\u2010h mean diastolic blood pressure \u226580\u00a0mmHg with systolic pressure &lt;130\u00a0mmHg, 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\u20133.77). Addition of DMS attenuated but did not eliminate the IDH association and provided independent incremental information (OR 1.44 per 5\u00a0mmHg, 95% CI 1.09\u20131.90). Incorporation of DMS improved discrimination (AUC 0.76 to 0.81;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.041), strengthened calibration, reduced overall prediction error, and provided greater net clinical benefit across intermediate risk thresholds. Ambulatory\u2010defined 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\u2010based discrimination and phenotypic characterization of LVDD.\n                  <\/jats:p>","DOI":"10.1111\/jch.70299","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:41:28Z","timestamp":1781581288000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diastolic Morning Surge Improves Risk Stratification for Subclinical Left Ventricular Diastolic Dysfunction in Ambulatory\u2010Defined Isolated Diastolic Hypertension"],"prefix":"10.1111","volume":"28","author":[{"given":"Ayhan","family":"Cosgun","sequence":"first","affiliation":[{"name":"Department of Cardiology TC Saglik Bakanligi Cihanbeyli Devlet Hastanesi  Cihanbeyli Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin","family":"Oren","sequence":"additional","affiliation":[{"name":"Department of Cardiology TC Saglik Bakanligi Ankara Sehir Hastanesi  \u00c7ankaya Ankara 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