title: Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians.
abstract: BACKGROUND
  The objective of this study was to examine whether definite hypertension and borderline isolated systolic hypertension predict subsequent cardiovascular disease and mortality.
  
  
  RESULTS
  This was a prospective cohort study with a mean follow-up of 11.7 years. The subjects were a group of 18,682 apparently healthy US men, aged 40 to 84 years, participating in the Physicians' Health Study, a randomized trial of low-dose aspirin and beta-carotene. The main outcome measures were total cardiovascular disease, myocardial infarction, stroke, cardiovascular death, and all-cause mortality. Hypertension was associated with substantially increased risks of total cardiovascular disease (relative risk [RR] 1.92; 95% confidence interval [CI], 1.70 to 2.18), myocardial infarction (RR,1.78; 95% CI, 1.49 to 2.13), stroke (RR, 2.19; 95% CI, 1.78 to 2.69), and cardiovascular death (RR, 2.10; 95% CI, 1.68 to 2.63). Borderline isolated systolic hypertension was associated with significantly increased risks of cardiovascular disease (RR, 1.32; 95% CI, 1.09 to 1.59), stroke (RR, 1.42; 95% CI, 1.04 to 1.93), and cardiovascular death (RR, 1.56; 95% CI, 1.13 to 2.15), as well as a possible but non-significant increased risk of myocardial infarction (RR, 1.26; 95% CI, 0.95 to 1.67). Hypertension and borderline isolated systolic hypertension were associated with significantly increased risks of 41% and 22%, respectively, for all-cause mortality.
  
  
  CONCLUSIONS
  Hypertension as well as borderline isolated systolic hypertension are associated with elevated risks of cardiovascular diseases, especially stroke and cardiovascular death. Hypertension is associated with an increased risk of myocardial infarction, and borderline isolated systolic hypertension predicts a possible but more modest increase in risk. These data add to the existing evidence that hypertension is a major cardiovascular risk factor and extend the findings to borderline isolated systolic hypertension.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA. chris@fram.nhlbi.nih.gov
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: P M
authors.initials: PM
authors.lastname: Ridker
authors.forename: R J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: K
authors.initials: K
authors.lastname: Berger
authors.forename: U
authors.initials: U
authors.lastname: Ajani
authors.forename: J E
authors.initials: JE
authors.lastname: Manson
authors.forename: C H
authors.initials: CH
authors.lastname: Hennekens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D016001:Confidence Intervals; D005163:Factor Analysis, Statistical; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D010820:Physicians; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019207:beta Carotene / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D010975:Platelet Aggregation Inhibitors; D019207:beta Carotene; D001241:Aspirin