Isolated Systolic Hypertension Is a Strong Predictor of Cardiovascular and All-Cause Mortality in the Middle-Aged Population: Warsaw Pol-MONICA Follow up Project.
OBJECTIVE: To assess the long-term risk of cardiovascular disease and all-cause mortality associated with various categories of hypertension, particularly isolated systolic hypertension. MATERIALS AND METHODS: Three independent random samples of the general Warsaw population aged 35-64 years (2490 men and 2405 women screened in 1984, 1988, and 1993) were followed for (1) cardiovascular death until 1996 and (2) all-cause death until 1998. Methods of the baseline surveys were consistent with the manual of the WHO MONICA Project. Isolated systolic hypertension was defined as systolic blood pressure greater than or equal to 140 mm Hg and diastolic blood pressure less than 90 mm Hg and was classified into two stages: stage I, when 90 is less than systolic blood pressure is less than 160 mm Hg; and stage II, for subjects with systolic blood pressure greater than or equal to 160 mm Hg. The Cox proportional hazard model was used to calculate the multivariable-adjusted relative risk of cardiovascular disease and all-cause mortality attributed to the particular hypertension category. RESULTS: Compared to normotension, stage I was associated with a 53%-60% increase in age-standardized cardiovascular mortality rates in both genders and with a 70% increase in all-cause mortality in men. A significant and independent association (after multivariable adjustment) was found only for all-cause mortality in men. Stage II was an independent predictor of cardiovascular mortality in men and in women, and of all-cause mortality in men. In both genders, the risks of examined end points associated with stage II were comparable to the risks associated with isolated systolic hypertension. Isolated diastolic hypertension did not significantly increase the risk of all-cause mortality in either gender or of cardiovascular mortality in men. In women the risk of cardiovascular disease associated with isolated diastolic hypertension was almost threefold higher compared with the normotensive group, but the risk was not statistically significant. CONCLUSION: In the middle-aged Polish population, isolated systolic hypertension is a much better predictor of cardiovascular disease and all-cause mortality than isolated diastolic hypertension. The association was stronger for stage II than for stage I. The risk of examined end points associated with stage II were similar to those associated with combined systolic-diastolic hypertension. (c)2000 by Le Jacq Communications, Inc.
Broda
Grazyna
G
Department of CVD Epidemiology and Prevention, National Institute of Cardiology, Warsaw, Poland.