Isolated Systolic Hypertension in 14 Communities1

Abstract

In the Hypertension Detection and Follow-up Program, 158,906 individuals from 14 communities around the United States had their blood pressure measured in their homes in 1972-1973. Of the total population screened, 2.4% had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg). Isolated systolic hypertension was present for 0.5% of those aged 30-39 years and 6.8% among those aged 60-69 years. The prevalence in blacks and women was greater than the prevalences in both whites and men. The prevalence among those taking antihypertensive medications at the time of screening was 6.1%, and 1.9% among those not on antihypertensive medications. From the individuals with "normal" diastolic blood pressure on the single home measurement (less than 90 mmHg), a random sample of 5,032 individuals were followed for mortality for eight years. Prevalence of isolated systolic hypertension was similar in this sample to that in the total. Among those not on antihypertensive medications, 8-year life table all-cause mortality rates adjusted for age, race, and sex were 17.6% for those with systolic blood pressure greater than or equal to 160 mmHg and 7.7% for those with systolic blood pressure greater than 160 mmHg. Among this population, all of whom had a diastolic blood pressure less than 90 mmHg, a multiple logistic analysis adjusting for baseline treatment status, age, race, sex, education, smoking, weight, pulse, physical activity, and systolic blood pressure revealed that each millimeter increase in systolic blood pressure was associated with approximately a 1% increase in mortality over the eight years of follow-up (p less than 0.05). Isolated systolic hypertension is both relatively common and a significant risk factor for subsequent mortality.

Pulse pressure and coronary mortality in elderly men and women from general population

“…Pulse pressure (PP), defined as the difference between SBP and diastolic BP (DBP), is usually employed to explore this component. In many studies, [3][4][5][6][7][8][9] subjects with higher PP were found to have a higher risk than subjects with lower PP values at the same age. Some of these studies, nevertheless, took into consideration hypertensive patients 10,11 or groups of subjects 12 rather than people from the general population, and the role of gender was often neglected.…”

Trends in the prevalence of isolated systolic hypertension in the middle-aged population in 1972–1992

“…22 The other studies that have determined the prevalence of ISH among middleaged men and women in the population have usually reported lower estimates than ours. [8][9][10][11]23,24 Since different methods have been used, the comparisons of prevalence estimates must, however, be interpreted with caution.…”

“…1,2 In most epidemiological studies, where multiple recordings are usually not possible, ISH has been defined as SBP у160 mm Hg in the presence of DBP of either less than 90 or 95 mm Hg. ISH has been associated with increased cardiovascular mortality and morbidity not only in the elderly 4,5 but also in middle-aged persons, [6][7][8][9][10][11] and a SBP level of 140-159 mm Hg already seems to increase the risk of CVD. 12,13 The prevalence of ISH increases in both sexes with age.…”

Isolated systolic hypertension: pathophysiology, consequences and therapeutic benefits

“…In the US Hypertension Detection and Follow-up Programme the mortality rate among those with ISH was 17.6%, and 7.5% in subjects with a BP within normal limits. 39 Multiple regression analysis showed that 1 mm Hg increase in SBP was associated with a 1% increase in mortality. Similar results were observed in the Multiple Risk Factor Intervention Trial (MRFIT).…”