Abstract 1452: Systolic Blood Pressure and Heart Failure Risk in the Elderly: The Health, Aging, and Body Composition Study
Background: High systolic blood pressure (SBP) is the most prevalent risk factor for heart failure (HF) and a primary target for cardiovascular risk reduction among older adults. Current recommendations suggest a target of <140 mmHg for treatment of SBP, with stricter targets for persons with diabetes mellitus. However, it is unclear whether this represents an optimal target for HF prevention in older adults.
Methods: The association of baseline SBP with 5-year HF rates was assessed with Cox proportional hazards models among 2621 older persons without prevalent HF enrolled in the Health ABC Study (age, 73.6±2.9 years; 47.2% men; 59.5% white). Of these, 1264 participants (48.2%) had documented history of hypertension and were receiving antihypertensive medications whereas 1357 (51.8%) reported no history of or medication use for hypertension; participants with conflicting information on hypertensive status were not included in this analysis. We evaluated SBP both as a continuous variable and as a categorical variable based on the JNC7 classification (Table 1⇓).
Results: At 5 years, 164 participants (6.3%) developed HF. Baseline SBP demonstrated a linear association with HF risk (HR per 10 mmHg, 1.22; 95% CI, 1.14 –1.31; P<.001); this association was similar in participants with and without treatment for hypertension (P=.37 for interaction), and persisted in models controlling for other previously identified clinical predictors of HF in Health ABC (HR per 10 mmHg, 1.19; 95% CI, 1.12–1.27; P<.001). When SBP was treated as a categorical variable (Table 1⇓), even a SBP of 120 –139 mmHg (pre-hypertension) at baseline was associated with increased risk for HF in adjusted models; this risk was more pronounced among those without a previous diagnosis of hypertension (Table 1⇓). These associations were consistent across sex and race.
Conclusion: The association of SBP with incident HF among older adults is continuous; SBP levels of 120 –139 mmHg are associated with increased HF risk.