Systolic–diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study. (15th May 2017)

• Record Type: Journal Article
• Authors: Tsimploulis, Apostolos; Sheriff, Helen M.; Lam, Phillip H.; Dooley, Daniel J.; Anker, Markus S.; Papademetriou, Vasilios; Fletcher, Ross D.; Faselis, Charles; Fonarow, Gregg C.; Deedwania, Prakash; White, Michel; Valentova, Miroslava; Blackman, Marc R.; Banach, Maciej; Morgan, Charity J.; Alagiakrishnan, Kannayiram; Allman, Richard M.; Aronow, Wilbert S.; Anker, Stefan D.; Ahmed, Ali
• Is Part Of: International journal of cardiology. Volume 235(2017)
• Page Start: 11
• Page End: 16
• Publication Date: 2017-05-15
• Subjects: Isolated diastolic hypertension -- Systolic–diastolic hypertension -- Incident heart failure -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.02.139
• Languages: English
• ISSNs: 0167-5273

Abstract

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 ≥ 65 years had data on baseline systolic and diastolic blood pressure (SBP and DBP). We excluded those with DBP < 60 mmHg ( n = 821), DBP ≥ 90 and SBP < 140 mmHg ( 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 < 90 mmHg) and 240 had SDH (SBP ≥ 140 and DBP ≥ 90 mmHg). The main outcome was centrally-adjudicated incident HF over 13 years 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.