title: Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study.
abstract: Hypertension is a risk factor for incident heart failure (HF). However, the effect of uncontrolled blood pressure (BP) on incident HF in older adults with hypertension has not been prospectively examined in propensity-matched studies. Of the 5795 Cardiovascular Health Study participants, > or =65 years, 2562 with self-reported physician-diagnosed hypertension had no baseline HF. Of these, 1391 had uncontrolled hypertension, defined as systolic BP (SBP) > or =140 (n = 1373) or diastolic BP > or =90 mm Hg (n = 18). Propensity scores for uncontrolled hypertension, calculated for each participant, were used to assemble a cohort of 1021 pairs of participants with controlled and uncontrolled hypertension who were balanced on 31 baseline characteristics. Centrally adjudicated incident HF developed in 23% and 26% of participants with controlled and uncontrolled hypertension respectively during 13 years of follow-up (matched hazard ratio [HR] when uncontrolled hypertension was compared with controlled hypertension, 1.39; 95% confidence interval [CI], 1.12 to 1.73; P = .003). HRs (95% CI) for incident HF for those with (n = 503) and without (n = 1539) chronic kidney disease (CKD) were 1.73 (95% CI, 1.26 to 2.38; P = .001) and 1.08 (95% CI, 0.87 to 1.34; P = .486) respectively (P for interaction, .012). Compared with participants with controlled hypertension, HRs for incident HF associated with SBP 140 to 159 and > or =160 mm Hg were 1.06 (95% CI, 0.86 to 1.31; P = .572) and 1.58 (95% CI, 1.27 to 1.96; P < .0001), respectively. In community-dwelling older adults with hypertension, those with uncontrolled (versus controlled) BP have increased risk of new-onset HF, which is more pronounced in those with SBP > or =160 mm Hg and with CKD.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Iyer
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: O James
authors.initials: OJ
authors.lastname: Ekundayo
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy*; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D016555:Matched-Pair Analysis; D011446:Prospective Studies; D012306:Risk
chemical_list: D000959:Antihypertensive Agents