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 journalArticle

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)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Aug 30 2016
Externally publishedYes

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Independent Living
Heart Failure
Hypertension
Health
African Americans
Antihypertensive Agents
Confidence Intervals
Blood Pressure
Mortality
Sex Characteristics
Hypotension
Age Groups

Keywords

  • Incident heart failure
  • Isolated diastolic hypertension
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Isolated diastolic hypertension and incident heart failure in community-dwelling older adults : Insights from the Cardiovascular Health Study. / Sheriff, Helen M.; Tsimploulis, Apostolos; Valentova, Miroslava; Anker, Markus S.; Deedwania, Prakash; Banach, Maciej; Morgan, Charity J.; Blackman, Marc R.; Fonarow, Gregg C.; White, Michel; Alagiakrishnan, Kannayiram; Allman, Richard M.; Aronow, Wilbert S.; Anker, Stefan D.; Ahmed, Ali.

In: International Journal of Cardiology, 30.08.2016.

Research output: Contribution to journalArticle

Sheriff, HM, Tsimploulis, A, Valentova, M, Anker, MS, Deedwania, P, Banach, M, Morgan, CJ, Blackman, MR, Fonarow, GC, White, M, Alagiakrishnan, K, Allman, RM, Aronow, WS, Anker, SD & Ahmed, A 2016, 'Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2017.02.142
Sheriff, Helen M. ; Tsimploulis, Apostolos ; Valentova, Miroslava ; Anker, Markus S. ; Deedwania, Prakash ; Banach, Maciej ; Morgan, Charity J. ; Blackman, Marc R. ; Fonarow, Gregg C. ; White, Michel ; Alagiakrishnan, Kannayiram ; Allman, Richard M. ; Aronow, Wilbert S. ; Anker, Stefan D. ; Ahmed, Ali. / Isolated diastolic hypertension and incident heart failure in community-dwelling older adults : Insights from the Cardiovascular Health Study. In: International Journal of Cardiology. 2016.
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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.",
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T1 - Isolated diastolic hypertension and incident heart failure in community-dwelling older adults

T2 - Insights from the Cardiovascular Health Study

AU - Sheriff, Helen M.

AU - Tsimploulis, Apostolos

AU - Valentova, Miroslava

AU - Anker, Markus S.

AU - Deedwania, Prakash

AU - Banach, Maciej

AU - Morgan, Charity J.

AU - Blackman, Marc R.

AU - Fonarow, Gregg C.

AU - White, Michel

AU - Alagiakrishnan, Kannayiram

AU - Allman, Richard M.

AU - Aronow, Wilbert S.

AU - Anker, Stefan D.

AU - Ahmed, Ali

PY - 2016/8/30

Y1 - 2016/8/30

N2 - 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.

AB - 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.

KW - Incident heart failure

KW - Isolated diastolic hypertension

KW - Mortality

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