Isolated Diastolic Hypotension and Incident Heart Failure in Older Adults

Abstract

Aging is often associated with increased systolic blood pressure and decreased diastolic blood pressure. Isolated systolic hypertension or an elevated systolic blood pressure without an elevated diastolic blood pressure is a known risk factor for incident heart failure in older adults. In the current study, we examined whether isolated diastolic hypotension, defined as a diastolic blood pressure <60 mm Hg and a systolic blood pressure ≥100 mm Hg, is associated with incident heart failure. Of the 5795 Medicare-eligible community-dwelling adults age ≥65 years in the Cardiovascular Health Study, 5521 were free of prevalent heart failure at baseline. After excluding 145 individuals with baseline systolic blood pressure <100 mm Hg, the final sample included 5376 participants, of whom 751 (14%) had isolated diastolic hypotension. Propensity scores for isolated diastolic hypotension were calculated for each of the 5376 participants and used to match 545 and 2348 participants with and without isolated diastolic hypotension, respectively who were balanced on 58 baseline characteristics. During over 12 years of median follow-up, centrally-adjudicated incident heart failure developed in 25% and 20% of matched participants with and without isolated diastolic hypotension respectively (hazard ratio associated with isolated diastolic hypotension, 1.33; 95% confidence interval, 1.10–1.61; p=0.004). Among the 5376 pre-match individuals, multivariable-adjusted hazard ratio for incident heart failure associated with isolated diastolic hypotension was 1.29 (95% confidence interval, 1.09–1.53; p=0.003). As in isolated systolic hypertension, among community-dwelling older adults without prevalent heart failure, isolated diastolic hypotension is also a significant independent risk factor for incident heart failure.

Aging, Blood Pressure, and Heart Failure

“…The findings of this study by Guichard et al 17 should be interpreted within the context of its limitations. The definition of isolated diastolic hypotension can be questioned.…”

“…17 Using the community-dwelling Cardiovascular Health Study population that was free of centrally adjudicated heart failure at baseline, Guichard et al 17 identified isolated diastolic hypotension (defined as DBP <60 mm Hg with SBP ≥100 mm Hg) as a new biomarker of incident heart failure. They identified 5376 subjects free of heart failure, of whom 751 (14%) fit the diagnosis of isolated diastolic hypotension.…”

“…Despite the potential limitations of the definition of isolated diastolic hypotension as formulated by Guichard et al, 17 the prediction of incident heart failure on the basis of low DBP represents a novel finding. If these observations can be confirmed in future longitudinal studies, other important questions beg answers.…”

Calcium Channel Blockers and Outcomes in Older Patients With Heart Failure and Preserved Ejection Fraction

“…23, 24 The effectiveness of propensity score model was assessed by estimating absolute standardized differences, and results were presented as a Love plot (Figure 1). 25–27 Absolute standardized differences values <10% are considered inconsequential and 0% indicates no residual bias.…”

Association of N-Terminal Pro B-Type Natriuretic Peptide With Blood Pressure and Pulse Pressure in Elderly People ― A Cross-Sectional Population Study ―

“…Participants were divided into five groups based on SBP High NT-proBNP** 1,790 (27) Unless indicated otherwise, data are given as the mean ± SD, n (%), or as the median [interquartile range]. *Hypertension was defined as being on antihypertensive medications and/or SBP ≥140 mmHg and/or DBP ≥90 mmHg.…”