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. 2017 Jul 1:238:140-143.
doi: 10.1016/j.ijcard.2017.02.142. Epub 2017 Mar 1.

Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study

Helen M Sheriff  1 , Apostolos Tsimploulis  2 , Miroslava Valentova  3 , Markus S Anker  4 , Prakash Deedwania  5 , Maciej Banach  6 , Charity J Morgan  7 , Marc R Blackman  8 , Gregg C Fonarow  9 , Michel White  10 , Kannayiram Alagiakrishnan  11 , Richard M Allman  12 , Wilbert S Aronow  13 , Stefan D Anker  3 , Ali Ahmed  14
Affiliations

Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study

Helen M Sheriff et al. Int J Cardiol. .

Abstract

Background: Isolated systolic hypertension and isolated diastolic hypotension are common in older adults and associated with a higher risk of incident heart failure (HF). However, little is known about the prevalence and impact of isolated diastolic hypertension in this population.

Methods: In the Cardiovascular Health Study (CHS), of the 5776 community-dwelling older adults ≥65years who had data on baseline systolic and diastolic blood pressure (SBP and DBP), 28 had isolated diastolic hypertension (DBP ≥90mmHg and SBP <140mmHg). From the 5748 without isolated diastolic hypertension, we excluded those with SBP ≥120mmHg (n=4451), DBP 80-89mmHg (n=20), DBP <60mmHg (n=425), normal BP taking anti-hypertensive medications (n=311), normal BP taking no anti-hypertensive medications but with history of hypertension (n=38), and baseline HF (n=5). The final cohort of 524 participants included 27 with isolated diastolic hypertension.

Results: Patients (n=524) had a mean (±SD) age of 71 (±5) years, 58% were women and 9% African American. There were no significant between-group age or sex differences; 37% of those with isolated diastolic hypertension (versus 7% without) were African American. Incident HF occurred in 19% and 7% of participants with and without isolated diastolic hypertension, respectively (multivariable-adjusted hazard ratio {HR}, 4.65; 95% confidence interval {CI}, 1.09-19.90; p=0.038). There was a trend toward higher cardiovascular mortality (HR, 4.59; 95% CI, 0.92-23.88; p=0.063).

Conclusion: Among community-dwelling older adults, isolated diastolic hypertension is rare and is associated with higher risk for incident HF and cardiovascular mortality.

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

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Figures

Figure 1
Figure 1
Survival plots for incident heart failure by isolated diastolic hypertension based on multivariable-adjusted Cox regression model (CI=confidence interval)
See this image and copyright information in PMC

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