title: Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study.
abstract: BACKGROUND
  Isolated systolic hypertension (ISH) is common in older adults and is a risk factor for incident heart failure (HF). We examined the association of systolic-diastolic hypertension (SDH) with incident HF and other outcomes in older adults.
  
  
  METHODS
  In the Cardiovascular Health Study (CHS), 5776 community-dwelling adults≥65years had data on baseline systolic and diastolic blood pressure (SBP and DBP). We excluded those with DBP<60mmHg (n=821), DBP≥90 and SBP<140mmHg (n=28), normal BP, taking anti-hypertensive drugs (n=1138), normal BP, not taking anti-hypertensive drugs, history of hypertension (n=193), and baseline HF (n=101). Of the remaining 3495, 1838 had ISH (SBP≥140 and DBP<90mmHg) and 240 had SDH (SBP≥140 and DBP≥90mmHg). The main outcome was centrally-adjudicated incident HF over 13years of follow-up.
  
  
  RESULTS
  Participants had a mean (±SD) age of 73 (±6)years, 57% were women, and 16% African American. Incident HF occurred in 25%, 22% and 11% of participants with ISH, SDH and no hypertension, respectively. Compared to no hypertension, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident HF associated with ISH and SDH were 1.86 (1.51-2.30) and 1.73 (1.23-2.42), respectively. Cardiovascular mortality occurred in 22%, 24% and 9% of those with ISH, SDH and no hypertension, respectively with respective multivariable-adjusted HRs (95% CIs) of 1.88 (1.49-2.37) and 2.30 (1.64-3.24).
  
  
  CONCLUSIONS
  Among older adults with hypertension, both SDH and ISH have similar associations with incident HF and cardiovascular mortality.
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsimploulis
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Sheriff
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Lam
authors.affiliation: Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Dooley
authors.affiliation: Charité Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany. Electronic address: ankerms@aol.com.
authors.forename: Markus S
authors.initials: MS
authors.lastname: Anker
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.affiliation: Georgetown University, Washington, DC, USA.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; University of California, San Francisco, Fresno, CA, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.affiliation: University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Valentova
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; George Washington University, Washington, DC, USA.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Blackman
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: University of Alberta, Edmonton, Canada.
authors.forename: Kannayiram
authors.initials: K
authors.lastname: Alagiakrishnan
authors.affiliation: Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: University of California, San Francisco, Fresno, CA, USA.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: aliahmedmdmph@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality; D003971:Diastole / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole / Q000502:physiology; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: Incident heart failure; Isolated diastolic hypertension; Mortality; Systolic–diastolic hypertension