Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study.

Pubmed ID: 28291625

Pubmed Central ID: PMC6454896

Journal: International journal of cardiology

Publication Date: May 15, 2017

MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Risk Factors, United States, Hypertension, Proportional Hazards Models, Heart Failure, Blood Pressure, Prospective Studies, Systole, Incidence, Diastole, Antihypertensive Agents

Grants: R01 HL085561, R01 HL097047, UL1 TR001409

Authors: White M, Aronow WS, Ahmed A, Anker SD, Fonarow GC, Deedwania P, Allman RM, Banach M, Morgan CJ, Fletcher RD, Alagiakrishnan K, Papademetriou V, Sheriff HM, Tsimploulis A, Valentova M, Anker MS, Blackman MR, Lam PH, Dooley DJ, Faselis C

Cite As: Tsimploulis A, Sheriff HM, Lam PH, Dooley DJ, Anker MS, Papademetriou V, Fletcher RD, Faselis C, Fonarow GC, Deedwania P, White M, Valentova M, Blackman MR, Banach M, Morgan CJ, Alagiakrishnan K, Allman RM, Aronow WS, Anker SD, Ahmed A. Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study. Int J Cardiol 2017 May 15;235:11-16. Epub 2017 Mar 1.

Studies:

Abstract

BACKGROUND: Isolated systolic hypertension (ISH) is common in older adults and is a risk factor for incident heart failure (HF). We examined the association of systolic-diastolic hypertension (SDH) with incident HF and other outcomes in older adults. METHODS: In the Cardiovascular Health Study (CHS), 5776 community-dwelling adults≥65years had data on baseline systolic and diastolic blood pressure (SBP and DBP). We excluded those with DBP<60mmHg (n=821), DBP≥90 and SBP<140mmHg (n=28), normal BP, taking anti-hypertensive drugs (n=1138), normal BP, not taking anti-hypertensive drugs, history of hypertension (n=193), and baseline HF (n=101). Of the remaining 3495, 1838 had ISH (SBP≥140 and DBP<90mmHg) and 240 had SDH (SBP≥140 and DBP≥90mmHg). The main outcome was centrally-adjudicated incident HF over 13years of follow-up. RESULTS: Participants had a mean (±SD) age of 73 (±6)years, 57% were women, and 16% African American. Incident HF occurred in 25%, 22% and 11% of participants with ISH, SDH and no hypertension, respectively. Compared to no hypertension, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident HF associated with ISH and SDH were 1.86 (1.51-2.30) and 1.73 (1.23-2.42), respectively. Cardiovascular mortality occurred in 22%, 24% and 9% of those with ISH, SDH and no hypertension, respectively with respective multivariable-adjusted HRs (95% CIs) of 1.88 (1.49-2.37) and 2.30 (1.64-3.24). CONCLUSION: Among older adults with hypertension, both SDH and ISH have similar associations with incident HF and cardiovascular mortality.