Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study.
BACKGROUND
Isolated systolic hypertension and isolated diastolic hypotension are common in older adults and associated with a higher risk of incident heart failure (HF). However, little is known about the prevalence and impact of isolated diastolic hypertension in this population.


METHODS
In the Cardiovascular Health Study (CHS), of the 5776 community-dwelling older adults ≥65years who had data on baseline systolic and diastolic blood pressure (SBP and DBP), 28 had isolated diastolic hypertension (DBP ≥90mmHg and SBP <140mmHg). From the 5748 without isolated diastolic hypertension, we excluded those with SBP ≥120mmHg (n=4451), DBP 80-89mmHg (n=20), DBP <60mmHg (n=425), normal BP taking anti-hypertensive medications (n=311), normal BP taking no anti-hypertensive medications but with history of hypertension (n=38), and baseline HF (n=5). The final cohort of 524 participants included 27 with isolated diastolic hypertension.


RESULTS
Patients (n=524) had a mean (±SD) age of 71 (±5) years, 58% were women and 9% African American. There were no significant between-group age or sex differences; 37% of those with isolated diastolic hypertension (versus 7% without) were African American. Incident HF occurred in 19% and 7% of participants with and without isolated diastolic hypertension, respectively (multivariable-adjusted hazard ratio {HR}, 4.65; 95% confidence interval {CI}, 1.09-19.90; p=0.038). There was a trend toward higher cardiovascular mortality (HR, 4.59; 95% CI, 0.92-23.88; p=0.063).


CONCLUSIONS
Among community-dwelling older adults, isolated diastolic hypertension is rare and is associated with higher risk for incident HF and cardiovascular mortality.
Veterans Affairs Medical Center, Washington, DC, USA.
Helen M
HM
Sheriff
Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA.
Apostolos
A
Tsimploulis
Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
Miroslava
M
Valentova
Charité Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany.
Markus S
MS
Anker
University of California, San Francisco, Fresno, California, USA.
Prakash
P
Deedwania
Medical University of Lodz, Lodz, Poland.
Maciej
M
Banach
University of Alabama at Birmingham, Birmingham, AL, USA.
Charity J
CJ
Morgan
Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; George Washington University, Washington, DC, USA.
Marc R
MR
Blackman
University of California, Los Angeles, California, USA.
Gregg C
GC
Fonarow
Montreal Heart Institute, Montreal, Quebec, Canada.
Michel
M
White
University of Alberta, Alberta, Canada.
Kannayiram
K
Alagiakrishnan
Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, USA.
Richard M
RM
Allman
Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Wilbert S
WS
Aronow
Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
Stefan D
SD
Anker
Veterans Affairs Medical Center, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA; George Washington University, Washington, DC, USA. Electronic address: aliahmedmdmph@gmail.com.
Ali
A
Ahmed
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D057187:Independent Living / Q000639:trends; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
Incident heart failure; Isolated diastolic hypertension; Mortality