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September 9, 1992

Isolated Systolic Hypertension and Subclinical Cardiovascular Disease in the ElderlyInitial Findings From the Cardiovascular Health Study

Author Affiliations

From the Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (Dr Psaty); Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Furberg); Department of Epidemiology, University of Pittsburgh (Pa) (Dr Kuller); Cardiovascular Health Study Coordinating Center, Seattle, Wash (Dr Borhani); Department of Medicine, University of Alberta, Edmonton, Canada (Dr Rautaharju); Geisinger Medical Center, Danville, Pa (Dr O'Leary); Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Bild); Department of Medicine, University of California, Davis (Dr Robbins); Department of Medicine, The Johns Hopkins University, Baltimore, Md (Dr Fried); and Department of Medicine, University of California, Irvine (Dr Reid).

JAMA. 1992;268(10):1287-1291. doi:10.1001/jama.1992.03490100085032

Objective.  —To assess the association between isolated systolic hypertension (ISH) and subclinical disease in adults aged 65 years and above.

Design.  —Medicare eligibility lists were used to obtain a representative sample of 5201 community-dwelling elderly persons for the Cardiovascular Health Study, a National Heart, Lung, and Blood Institute—sponsored cohort study of risk factors for coronary heart disease and stroke. In this cross-sectional analysis of baseline data, we excluded 3012 participants who were receiving antihypertensive medications, had clinical cardiovascular disease, or had a diastolic blood pressure of at least 90 mm Hg.

Main Outcome Measures.  —For electrocardiogram: myocardial infarction, left ventricular hypertrophy, and left ventricular mass as measures of myocardial damage and strain; for echocardiography: left ventricular mass, fractional shortening, and Doppler flow velocities as measures of cardiac systolic and diastolic function; and for carotid sonography: carotid arterial intima-media thickness as a measure of atherosclerosis.

Results.  —Among the 2189 men and women in this analysis, 195 (9%) had ISH (systolic blood pressure, ≥160 mm Hg) and 596 (23%) had borderline ISH (systolic blood pressure, 140 to 159 mm Hg). Systolic blood pressure was associated with myocardial infarction by electrocardiogram (P=.02). Borderline and definite ISH were strongly associated with left ventricular mass (P<.001). While there was little association with cardiac systolic function, borderline and definite ISH were associated with cardiac diastolic function (P<.001). Isolated systolic hypertension was also strongly associated with increased intima-media thickness of the carotid artery (P<.001).

Conclusions.  —While cohort analyses of future repeated measures will provide a better assessment of risk, both borderline and definite ISH were strongly related to a variety of measures of subclinical disease in elderly men and women.(JAMA. 1992;268:1287-1291)