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

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.

• Authors: Apostolos Tsimploulis, Helen M Sheriff, Phillip H Lam, Daniel J Dooley, Markus S Anker, Vasilios Papademetriou, Ross D Fletcher, Charles Faselis, Gregg C Fonarow, Prakash Deedwania, Michel White, Miroslava Valentova, Marc R Blackman, Maciej Banach, Charity J Morgan, Kannayiram Alagiakrishnan, Richard M Allman, Wilbert S Aronow, Stefan D Anker, Ali Ahmed
• Journal: International journal of cardiology (Int J Cardiol) Vol. 235 Pg. 11-16 (May 15 2017) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 28291625 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Published by Elsevier B.V.

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Blood Pressure (drug effects, physiology)
• Cardiovascular Diseases (mortality)
• Diastole (physiology)
• Female
• Heart Failure (diagnosis, epidemiology, etiology, physiopathology)
• Humans
• Hypertension (diagnosis, drug therapy, physiopathology)
• Incidence
• Male
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Systole (physiology)
• United States (epidemiology)