title: The dominant role of systolic hypertension as a vascular risk factor: evidence from the southeastern United States.
abstract: A high burden of hypertension-related cardiovascular disease remains an unfortunate hallmark in the southeastern United States (also known as the Stroke Belt). A convergence of factors related to aging, systolic blood pressure (BP), and hypertension control rates indicate that the Southeast burden will remain and probably increase well into the next century unless strategic initiatives are undertaken soon. More specifically, systolic BP, which is a major independent risk factor, increases as a function of age, whereas diastolic BP reaches a plateau. Given a selective immigration of elderly residents from other areas of the country, the Southeast is "aging" more rapidly. Thus, isolated systolic hypertension (ISH), which carries a very high relative risk, is likely to increase at a faster rate in the Southeast than in other areas of the U.S. Moreover, control rates for systolic BP are poorer than for diastolic BP. Hypertension control rates are also lower in elderly people than in younger patients with hypertension. In the absence of a paradigm shift in medical practice, control rates will decline as the prevalence of ISH rises in an aging population. The health and economic implications of an inadequate response to this challenge are imposing, particularly for the Southeast. On a positive note, the emerging recognition of systolic BP as a significant risk factor may lead to more appropriate recognition and higher rates of treatment and control. Randomized, controlled clinical trials have clearly established that treatment reduces BP in the elderly patient with ISH and combined systolic-diastolic hypertension. Moreover, treatment dramatically reduces hypertension-related cardiovascular complications among elderly patients with hypertension. In summary, the Southeast will lead the aging of the nation into the next century. The implications of this large demographic shift are likely to worsen rather than reduce the relative burden of cardiovascular disease in the Stroke Belt. Thus, a high priority should be given to the recognition, treatment, and control of systolic hypertension in the Southeast.
authors.affiliation: Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston 29425, USA. lackland@musc.edu
authors.forename: D T
authors.initials: DT
authors.lastname: Lackland
authors.forename: B M
authors.initials: BM
authors.lastname: Egan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015144:Southeastern United States / Q000453:epidemiology; D013599:Systole