title: Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study.
abstract: BACKGROUND
  The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs.
  
  
  OBJECTIVE
  To examine the association between SBP and HF risk in the elderly.
  
  
  METHODS
  Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989-90 and 1992-3) and the Health ABC Study (inception: 1997-8).
  
  
  METHODS
  Community-based cohorts.
  
  
  METHODS
  4408 participants (age, 72.8 (4.9) years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive drugs at baseline.
  
  
  METHODS
  Incident HF, defined as first adjudicated hospitalisation for HF.
  
  
  RESULTS
  Over 10 years, 493 (11.2%) participants developed HF. Prehypertension (120-139 mm Hg), stage 1 (140-159 mm Hg), and stage 2 (≥160 mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (<120 mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI 1.23 to 2.16; p=0.001), 2.21 (95% CI 1.65 to 2.96; p<0.001) and 2.60 (95% CI 1.85 to 3.64; p<0.001), respectively. Overall 255/493 (51.7%) HF events occurred in participants with SBP <140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race-SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women.
  
  
  CONCLUSIONS
  There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mm Hg; over half of incident HF events occur in individuals with SBP <140 mm Hg.
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. javed.butler@emory.edu
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Samer S
authors.initials: SS
authors.lastname: Najjar
authors.forename: Kim C
authors.initials: KC
authors.lastname: Sutton-Tyrrell
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology