title: Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study.
abstract: BACKGROUND
  Isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, in younger and middle-aged adults is increasing in prevalence.
  
  
  OBJECTIVE
  The aim of this study was to assess the risk for cardiovascular disease (CVD) with ISH in younger and middle-aged adults.
  
  
  METHODS
  CVD risks were explored in 15,868 men and 11,213 women 18 to 49 years of age (mean age 34 years) at baseline, 85% non-Hispanic white, free of coronary heart disease (CHD) and antihypertensive therapy, from the Chicago Heart Association Detection Project in Industry study. Participant classifications were as follows: 1) optimal-normal blood pressure (BP) (SBP <130 mm Hg and DBP <85 mm Hg); 2) high-normal BP (130 to 139/85 to 89 mm Hg); 3) ISH; 4) isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg); and 5) systolic diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg).
  
  
  RESULTS
  During a 31-year average follow-up period (842,600 person-years), there were 1,728 deaths from CVD, 1,168 from CHD, and 223 from stroke. Cox proportional hazards models were adjusted for age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men, with optimal-normal BP as the reference stratum, hazard ratios for CVD and CHD mortality risk for those with ISH were 1.23 (95% confidence interval [CI]: 1.03 to 1.46) and 1.28 (95% CI: 1.04 to 1.58), respectively. ISH risks were similar to those with high-normal BP and less than those associated with isolated diastolic hypertension and systolic diastolic hypertension. In women with ISH, hazard ratios for CVD and CHD mortality risk were 1.55 (95% CI: 1.18 to 2.05) and 2.12 (95% CI: 1.49 to 3.01), respectively. ISH risks were higher than in those with high-normal BP or isolated diastolic hypertension and less than those associated with systolic diastolic hypertension.
  
  
  CONCLUSIONS
  Over long-term follow-up, younger and middle-aged adults with ISH had higher relative risk for CVD and CHD mortality than those with optimal-normal BP.
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Yuichiro
authors: Y
authors: Yano
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Jeremiah
authors: J
authors: Stamler
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois.
authors: Daniel B
authors: DB
authors: Garside
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois.
authors: Martha L
authors: ML
authors: Daviglus
authors: Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, Irvine, California.
authors: Stanley S
authors: SS
authors: Franklin
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Mercedes R
authors: MR
authors: Carnethon
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Kiang
authors: K
authors: Liu
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Philip
authors: P
authors: Greenland
authors: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: dlj@northwestern.edu.
authors: Donald M
authors: DM
authors: Lloyd-Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality*; D002641:Chicago / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: cardiovascular risk; long-term follow-up; younger adults
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