Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study.

Pubmed ID: 20374948

Pubmed Central ID: PMC2914566

Journal: Journal of the American Society of Hypertension : JASH

Publication Date: Jan. 1, 2010

MeSH Terms: Humans, Male, Female, Aged, Hypertension, Chronic Disease, Heart Failure, Prospective Studies, Follow-Up Studies, Incidence, Kidney Diseases, Risk, Antihypertensive Agents, Matched-Pair Analysis

Grants: R01 HL085561, R01 HL085561-04, R01 HL097047, R01 HL097047-01, R01-HL097047, R01HL085561

Authors: Ahmed MI, Ekundayo OJ, Love TE, Aronow WS, Ahmed A, Filippatos GS, Fonarow GC, Aban IB, Bakris GL, Iyer AS, Nanda NC

Cite As: Iyer AS, Ahmed MI, Filippatos GS, Ekundayo OJ, Aban IB, Love TE, Nanda NC, Bakris GL, Fonarow GC, Aronow WS, Ahmed A. Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study. J Am Soc Hypertens 2010 Jan-Feb;4(1):22-31.

Studies:

Abstract

Hypertension is a risk factor for incident heart failure (HF). However, the effect of uncontrolled blood pressure (BP) on incident HF in older adults with hypertension has not been prospectively examined in propensity-matched studies. Of the 5795 Cardiovascular Health Study participants, > or =65 years, 2562 with self-reported physician-diagnosed hypertension had no baseline HF. Of these, 1391 had uncontrolled hypertension, defined as systolic BP (SBP) > or =140 (n = 1373) or diastolic BP > or =90 mm Hg (n = 18). Propensity scores for uncontrolled hypertension, calculated for each participant, were used to assemble a cohort of 1021 pairs of participants with controlled and uncontrolled hypertension who were balanced on 31 baseline characteristics. Centrally adjudicated incident HF developed in 23% and 26% of participants with controlled and uncontrolled hypertension respectively during 13 years of follow-up (matched hazard ratio [HR] when uncontrolled hypertension was compared with controlled hypertension, 1.39; 95% confidence interval [CI], 1.12 to 1.73; P = .003). HRs (95% CI) for incident HF for those with (n = 503) and without (n = 1539) chronic kidney disease (CKD) were 1.73 (95% CI, 1.26 to 2.38; P = .001) and 1.08 (95% CI, 0.87 to 1.34; P = .486) respectively (P for interaction, .012). Compared with participants with controlled hypertension, HRs for incident HF associated with SBP 140 to 159 and > or =160 mm Hg were 1.06 (95% CI, 0.86 to 1.31; P = .572) and 1.58 (95% CI, 1.27 to 1.96; P < .0001), respectively. In community-dwelling older adults with hypertension, those with uncontrolled (versus controlled) BP have increased risk of new-onset HF, which is more pronounced in those with SBP > or =160 mm Hg and with CKD.