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

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