Abstract 18649: Comparative Impact of Isolated Systolic Hypertension vs Systolic-Diastolic Hypertension on Incident Heart Failure and All-Cause Mortality in Community-Dwelling Older Adults
Background: Isolated systolic hypertension (ISH), increased systolic blood pressure (SBP) without increased diastolic blood pressure (DBP), is more common in older adults than systolic-diastolic hypertension (SDH) where both SBP and DBP may be increased. In the NHLBI-funded Cardiovascular Health Study (CHS), community-dwelling older adults aged ≥65 years with ISH had a mean DBP of 74 mm Hg (PMID: 19188527). In the HYVET trial, octogenarians with SDH had a mean DBP of 91 mm Hg (PMID: 18378519). Whether evidence from these trial-eligible older patients with SDH may be generalized to older adults with ISH remains unknown. In the current analysis, we examined associations of ISH and SDH with outcomes in CHS.
Methods: Of the 4645 CHS participants free of baseline HF and DBP ≥60 mm Hg (PMID: 21947466), 1838 (40%) had ISH (SBP>140 and DBP<90), 240 (5%) had SDH (SBP>140 and DBP>90) and 2567 (55%) had no-HTN. Cox regression models were used to estimate associations of ISH and SDH (vs. no HTN) with centrally-adjudicated incident HF and all-cause mortality during over 13 years of follow-up adjusting for demographics and major HF risk factors (AMI, DM, Afib, CKD, LVH and LVEF).
Results: Participants had a mean (±SD) age of 73 (±6) years, 57% were women, and 16% were African American. Unadjusted incident HF occurred in 25%, 22% and 16% of those with ISH, SDH and no-HTN, resp. Compared to no HTN, MV-adjusted HR (95% CI) for incident HF for those with ISH and SDH were 1.54 (1.33-1.76) and 1.37 (1.03-1.84), resp. (Figure). Unadjusted all-cause mortality occurred in 49%, 50% and 38% of those with ISH, SDH and no HTN, resp., with respective MV-adjusted HRs (95% CIs) of 1.15 (1.05-1.26) and 1.28 (1.06-1.55).
Conclusion: Among community-dwelling older adults without HF, ISH is more common than SDH but both contribute similarly to incident HF and all-cause mortality.
Author Disclosures: R.E. Kheirbek: None. R. Fletcher: None. P. Deedwania: None. N. Shara: None. G.C. Fonarow: None. M. Banach: None. M. White: None. W.S. Aronow: None. S.D. Anker: None. R.M. Allman: None. A. Ahmed: None.
- © 2014 by American Heart Association, Inc.