Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study

Helen M. Sheriff, Apostolos Tsimploulis, Miroslava Valentova, Markus S. Anker, Prakash Deedwania, Maciej Banach, Charity J. Morgan, Marc R. Blackman, Gregg C. Fonarow, Michel White, Kannayiram Alagiakrishnan, Richard M. Allman, Wilbert S. Aronow, Stefan D. Anker, Ali Ahmed

Research output: Contribution to journalArticlepeer-review

Abstract

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 ≥ 65 years who had data on baseline systolic and diastolic blood pressure (SBP and DBP), 28 had isolated diastolic hypertension (DBP ≥ 90 mm Hg and SBP < 140 mm Hg). From the 5748 without isolated diastolic hypertension, we excluded those with SBP ≥ 120 mm Hg (n = 4451), DBP 80–89 mm Hg (n = 20), DBP < 60 mm Hg (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). Conclusion Among community-dwelling older adults, isolated diastolic hypertension is rare and is associated with higher risk for incident HF and cardiovascular mortality.

Original languageEnglish (US)
Pages (from-to)140-143
Number of pages4
JournalInternational Journal of Cardiology
Volume238
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Keywords

  • Incident heart failure
  • Isolated diastolic hypertension
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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