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Isolated systolic hypertension increases HF risk in over-65s

Hypertension 2009; 53: 458–465

 Isolated systolic hypertension (ISH) in patients older than 65 years is associated with an increased risk for heart failure (HF) but not with all-cause mortality, a US population study has found.

The research involved 5795 ambulatory older adults who participated in the Cardiovascular Health Study. This is an ongoing longitudinal study of community-dwelling individuals living in four US states.

At baseline, 5248 participants had diastolic blood pressure <90 mmHg and were free of HF; of these, 2000 had ISH, defined as an average seated systolic BP of ≥140 mmHg.

For their analysis Ali Ahmed (University of Alabama at Birmingham, USA) and colleagues used 64 baseline covariates to calculate propensity scores for each participant. They then matched 1260 pairs of participants with and without ISH and examined the association between ISH and incident HF.

During a mean follow-up of 8.7 years, 18% of participants developed HF and 35% died, Ahmed et al reveal in journal Hypertension.

The incidence of HF was 20% in participants with ISH at baseline versus 16% in those without, giving a hazard ratio of 1.26 (p=0.016). Hazard ratios in unadjusted, multivariate-adjusted, and propensity-adjusted analyses were 1.72, 1.35, and 1.22, respectively, all supporting a highly significant association between ISH and new-onset HF.

By contrast there was no association between ISH and all-cause mortality (hazard ratio=1.03).

Ahmed and co-authors remark that the association between ISH and HF was particularly strong in participants with diabetes, higher serum glucose, or kidney disease at baseline, a finding that highlights the importance of controlling blood pressure in these patients.

“Elevated systolic blood pressure in older adults with ISH should be properly controlled to reduce cardiovascular morbidity, including HF,” the authors conclude.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Read the abstract