Abstract 19925: Isolated Diastolic Hypotension is a Risk Factor for Incident Heart Failure in Community-Dwelling Older Adults with Wide Pulse Pressure
Background: We have previously demonstrated that isolated diastolic hypotension is common in older adults and is associated with increased risk of heart failure (HF). However, it is not clear if this association would persist in those with wide pulse pressure.
Methods: Of the 5795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5504 participants were free of prevalent HF at baseline and had data on systolic and diastolic blood pressure (SBP, DBP). Of these, 5376 had SBP >100 mm Hg, of which 4333 had pulse pressure >50 mm Hg. Of the 4333 participants, 690 (16%) had IDH, defined as baseline DBP <60 mm Hg. Propensity scores for IDH, calculated for each participant, were used to assemble a matched cohort of 587 pairs of those with and without IDH who were balanced on 38 baseline characteristics. Matched Cox regression models were used to estimate the association of IDH with centrally-adjudicated incident HF during >12 years of follow-up.
Results: Matched participants had a mean (±SD) age of 75 (±6) years, 64% were women, and 8% were African American. Incident HF occurred in 26% and 19% of matched participants with and without IDH respectively (matched HR, 1.54; 95% CI, 1.15–2.06; p=0.003; Figure 1). This association could be replicated in the pre-match cohort (n=4333) using a multivariable regression model adjusting for the 38 covariates used in the propensity model. Incident HF occurred in 26% and 22% of pre-match participants with and without IDH respectively (adjusted HR, 1.36; 95% CI, 1.15–1.63; p=0.001).
Conclusions: Among community dwelling older adults without systolic hypotension and with a wide pulse pressure, isolated diastolic hypotension was associated with a significant increased risk of new-onset HF.
- © 2010 by American Heart Association, Inc.