Circulation, Vol 77, 504-514, Copyright © 1988 by American Heart Association
GH Rutan, LH Kuller, JD Neaton, DN Wentworth, RH McDonald and WM Smith
The large cohort of white men (317,871) 35 to 57 years old at initial
screening for possible enrollment into the Multiple Risk Factor
Intervention Trial (MRFIT) was examined with regard to initial blood
pressure levels and subsequent coronary heart disease (CHD), stroke, and
all-cause mortality. The overall prevalence of isolated systolic
hypertension (ISH), defined as systolic blood pressure (SBP) greater than
or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm
Hg, was 0.67% among white men screened for MRFIT and increased with age
(0.31% among 35- to 39-year-olds to 1.7% among 55- to 57-year- olds). The 6
year CHD and all-cause mortality rates in men over 50 were highest in those
with ISH compared with both subjects with diastolic hypertension and those
with normal pressure. The relative risk of death from stroke in those with
ISH, compared with that in those with SBP less than 160 mm Hg and those
with DBP less than 90 mm Hg, was 3.0 (95% confidence interval 1.3 to 6.8).
In addition, at any level of DBP, the level of SBP appeared to be the major
determinant of all-cause and CHD mortality. The determinants of ISH in
individuals under 60 years of age as well as the possible efficacy of its
treatment should be evaluated further.
ARTICLES
Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
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