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Isolated systolic hypertension in the elderly
1Department of Community Health, School of Medicine, University of California, Davis 95616.
Summary
Isolated systolic hypertension in the elderly is a significant risk factor for cardiovascular mortality. Further research is needed to determine the efficacy of treating this condition in older adults.
Area of Science:
- Cardiology
- Epidemiology
- Geriatrics
Background:
- Prospective cohort studies reveal a consistent association between elevated systolic blood pressure and increased mortality from cardiovascular diseases and stroke.
- Isolated systolic hypertension (ISH), defined as systolic blood pressure ≥160 mmHg and diastolic blood pressure <90 mmHg, is a potent risk factor for morbidity and mortality, particularly in the elderly.
- The prevalence of ISH increases significantly with age, affecting 8.5% of individuals aged 65-74 years and rising in older age groups.
Purpose of the Study:
- To examine the association between isolated systolic hypertension and mortality.
- To investigate the prevalence of isolated systolic hypertension in different age groups.
- To highlight the unanswered question regarding the efficacy of treating ISH in the elderly.
Main Methods:
- Analysis of prospective cohort epidemiological studies.
- Utilized data from the Hypertension Detection and Follow-Up Program (HDFP) and the Multiple Risk Factor Intervention Trial (MRFIT).
- Employed multiple logistic regression analysis and examined stroke mortality relative risks.
Main Results:
- In the 60-69 age group, a 1-mmHg increase in systolic blood pressure was associated with a 1% annual increase in mortality (P<0.05) after adjusting for other factors.
- Among individuals aged 55 and above in the MRFIT study, ISH was associated with a 3.0-fold increased risk of stroke mortality (95% CI: 1.3-6.8).
- The prevalence of ISH in the 65-74 age group was estimated at 8.5%, with higher rates in older individuals (6%, 11%, and 18% for ages 60-69, 70-79, and >80, respectively).
Conclusions:
- Isolated systolic hypertension is a significant and graded risk factor for cardiovascular mortality and stroke, especially in older populations.
- While treatment for diastolic hypertension in the elderly is effective, the efficacy of drug treatment for isolated systolic hypertension remains undetermined due to a lack of adequate prospective evaluations.