Observational Study

. 2017 May 15:235:11-16.

doi: 10.1016/j.ijcard.2017.02.139. Epub 2017 Mar 1.

Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study

Apostolos Tsimploulis¹, Helen M Sheriff², Phillip H Lam¹, Daniel J Dooley¹, Markus S Anker³, Vasilios Papademetriou⁴, Ross D Fletcher⁵, Charles Faselis⁶, Gregg C Fonarow⁷, Prakash Deedwania⁸, Michel White⁹, Miroslava Valentova¹⁰, Marc R Blackman¹¹, Maciej Banach¹², Charity J Morgan¹³, Kannayiram Alagiakrishnan¹⁴, Richard M Allman¹⁵, Wilbert S Aronow¹⁶, Stefan D Anker¹⁷, Ali Ahmed¹⁸

Affiliations

¹ Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
² Veterans Affairs Medical Center, Washington, DC, USA.
³ Charité Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany. Electronic address: ankerms@aol.com.
⁴ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA.
⁵ Georgetown University, Washington, DC, USA.
⁶ Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
⁷ University of California, Los Angeles, CA, USA.
⁸ Veterans Affairs Medical Center, Washington, DC, USA; University of California, San Francisco, Fresno, CA, USA.
⁹ Montreal Heart Institute, Montreal, Quebec, Canada.
¹⁰ University Medical Center Göttingen, Göttingen, Germany.
¹¹ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; George Washington University, Washington, DC, USA.
¹² Medical University of Lodz, Lodz, Poland.
¹³ University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ University of Alberta, Edmonton, Canada.
¹⁵ Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, USA.
¹⁶ Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
¹⁷ University of California, San Francisco, Fresno, CA, USA.
¹⁸ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aliahmedmdmph@gmail.com.

PMID: 28291625
PMCID: PMC6454896
DOI: 10.1016/j.ijcard.2017.02.139

Observational Study

Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study

Apostolos Tsimploulis et al. Int J Cardiol. 2017.

. 2017 May 15:235:11-16.

doi: 10.1016/j.ijcard.2017.02.139. Epub 2017 Mar 1.

Authors

Affiliations

¹ Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
² Veterans Affairs Medical Center, Washington, DC, USA.
³ Charité Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany. Electronic address: ankerms@aol.com.
⁴ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA.
⁵ Georgetown University, Washington, DC, USA.
⁶ Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
⁷ University of California, Los Angeles, CA, USA.
⁸ Veterans Affairs Medical Center, Washington, DC, USA; University of California, San Francisco, Fresno, CA, USA.
⁹ Montreal Heart Institute, Montreal, Quebec, Canada.
¹⁰ University Medical Center Göttingen, Göttingen, Germany.
¹¹ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; George Washington University, Washington, DC, USA.
¹² Medical University of Lodz, Lodz, Poland.
¹³ University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ University of Alberta, Edmonton, Canada.
¹⁵ Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, USA.
¹⁶ Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
¹⁷ University of California, San Francisco, Fresno, CA, USA.
¹⁸ Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aliahmedmdmph@gmail.com.

PMID: 28291625
PMCID: PMC6454896
DOI: 10.1016/j.ijcard.2017.02.139

Erratum in

Corrigendum to "Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the cardiovascular health study" [Int. J. Cardiol. 235 (2017) 11-16].
Tsimploulis A, Sheriff HM, Lam PH, Dooley DJ, Anker MS, Papademetriou V, Fletcher RD, Faselis C, Fonarow GC, Deedwania P, White M, Valentova M, Blackman MR, Banach M, Morgan CJ, Alagiakrishnan K, Allman RM, Aronow WS, Anker SD, Ahmed A. Tsimploulis A, et al. Int J Cardiol. 2017 Jul 1;238:181. doi: 10.1016/j.ijcard.2017.04.072. Epub 2017 May 6. Int J Cardiol. 2017. PMID: 28487149 No abstract available.

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

Keywords: Incident heart failure; Isolated diastolic hypertension; Mortality; Systolic–diastolic hypertension.

Published by Elsevier B.V.

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

**Figure 1**
Flow chart displaying assembly of study cohort based on the public-use copy of the Cardiovascular Health Study (CHS) data (BP=blood pressure; HTN=hypertension)

**Figure 2**
Multivariable-adjusted plots for incident heart failure by isolated systolic hypertension (ISH), systolic-diastolic hypertension (SDH), and no hypertension

**Figure 3**
Multivariable-adjusted plots for all-cause mortality by isolated systolic hypertension (ISH), systolic-diastolic hypertension (SDH), and no hypertension

See this image and copyright information in PMC

Comment in

Assessment of isolated systolic hypertension with lower diastolic and the risk of cardiovascular disease in older adults.
Wang S, Li J, Yan G, Sun M, Zhang Y. Wang S, et al. Int J Cardiol. 2017 Sep 1;242:20. doi: 10.1016/j.ijcard.2017.03.143. Int J Cardiol. 2017. PMID: 28619323 No abstract available.
Treatment of systolic hypertension and low diastolic blood pressure in older adults: How low is too low?!
Tsimploulis A, Sheriff HM, Anker MS, Deedwania P, Fletcher RD, Aronow WS, Anker SD, Ahmed A. Tsimploulis A, et al. Int J Cardiol. 2017 Sep 1;242:21. doi: 10.1016/j.ijcard.2017.04.096. Int J Cardiol. 2017. PMID: 28619324 No abstract available.

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Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study

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Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study

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