Tsimploulis Apostolos, Sheriff Helen M, Lam Phillip H, Dooley Daniel J, Anker Markus S, Papademetriou Vasilios, Fletcher Ross D, Faselis Charles, Fonarow Gregg C, Deedwania Prakash, White Michel, Valentova Miroslava, Blackman Marc R, Banach Maciej, Morgan Charity J, Alagiakrishnan Kannayiram, Allman Richard M, Aronow Wilbert S, Anker Stefan D, Ahmed Ali
Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA; Veterans Affairs Medical Center, Washington, DC, USA.
Veterans Affairs Medical Center, Washington, DC, USA.
Int J Cardiol. 2017 May 15;235:11-16. doi: 10.1016/j.ijcard.2017.02.139. Epub 2017 Mar 1.
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.
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.
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).
Among older adults with hypertension, both SDH and ISH have similar associations with incident HF and cardiovascular mortality.
单纯收缩期高血压（ISH）在老年人中很常见，是发生心力衰竭（HF）的危险因素。我们研究了收缩期-舒张期高血压（SDH）与老年人发生HF及其他结局的关联。
在心血管健康研究（CHS）中，5776名年龄≥65岁的社区居住成年人有基线收缩压和舒张压（SBP和DBP）数据。我们排除了舒张压<60mmHg者（n = 821）、舒张压≥90mmHg且收缩压<140mmHg者（n = 28）、血压正常且服用降压药者（n = 1138）、血压正常且未服用降压药但有高血压病史者（n = 193）以及基线时患有HF者（n = 101）。在其余3495人中，1838人患有ISH（收缩压≥140mmHg且舒张压<90mmHg），240人患有SDH（收缩压≥140mmHg且舒张压≥90mmHg）。主要结局是在13年随访期间经中心判定的HF发病情况。
参与者的平均（±标准差）年龄为73（±6）岁，57%为女性，16%为非裔美国人。ISH、SDH和无高血压的参与者中，HF发病率分别为25%、22%和11%。与无高血压相比，ISH和SDH相关的HF发病的多变量调整风险比（HR）及95%置信区间（CI）分别为1.86（1.51 - 2.30）和1.73（1.23 - 2.42）。ISH、SDH和无高血压者的心血管死亡率分别为22%、24%和9%，各自的多变量调整HR（95%CI）分别为1.88（1.49 - 2.37）和2.30（1.64 - 3.24）。
在患有高血压的老年人中，SDH和ISH与HF发病及心血管死亡率的关联相似。
