title: Cardiovascular remodeling is greater in isolated systolic hypertension than in diastolic hypertension in older adults: the Insufficienza Cardiaca negli Anziani Residenti (ICARE) a Dicomano Study.
abstract: OBJECTIVE
  We investigated cardiac and vascular remodeling in an unselected older population with either diastolic hypertension (HTN) or isolated systolic hypertension (ISH).
  
  
  BACKGROUND
  Isolated systolic hypertension accounts for a substantial proportion of hypertension in individuals older than 65 years and is strongly associated with an increased risk of cardiac and cerebrovascular events. The exact mechanisms underlying the increased risk associated with ISH and elevated pulse pressure (PP), in comparison with HTN, have not been extensively investigated.
  
  
  METHODS
  Community-dwelling residents age >/=65 years in a small town in Italy (Dicomano) were enrolled. Untreated subjects considered in this study included 173 normotensive subjects (blood pressure [BP] <140/90 mm Hg), 95 subjects with HTN (diastolic BP >/=90 mm Hg), and 43 subjects with ISH (BP >/=160/<90 mm Hg). All subjects underwent extensive clinical examination, echocardiography, carotid ultrasonography, and carotid applanation tonometry.
  
  
  RESULTS
  Subjects with ISH had higher left ventricular (LV) mass, which was independently related to PP but not to systolic or mean pressures. Both carotid wall cross-sectional area and vascular stiffness were greater in ISH patients than in HTN and normal subjects and were independently related to PP but not to systolic BP. In addition, ISH was associated with a higher prevalence of carotid plaque and more extensive carotid atherosclerosis.
  
  
  CONCLUSIONS
  In our community-based elderly population, individuals with ISH had higher prevalences of LV hypertrophy and carotid atherosclerosis than subjects with HTN despite lower mean BP. These findings provide potential pathophysiologic mechanisms underlying the associations of ISH and PP with increased risk of cardiovascular morbidity and mortality.
authors.affiliation: Department of Critical Care Medicine and Surgery-Unit of Gerontology and Geriatrics, University of Firenze and Azienda Ospedaliera Careggi, Firenze, Italy. rpini@unifi.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
authors.forename: M Chiara
authors.initials: MC
authors.lastname: Cavallini
authors.forename: Francesca
authors.initials: F
authors.lastname: Bencini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Silvestrini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tonon
authors.forename: Walter
authors.initials: W
authors.lastname: De Alfieri
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Giulio
authors.initials: G
authors.lastname: Masotti
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D013599:Systole; D020257:Ventricular Remodeling