Related Experiment Videos
Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the
G H Rutan1, L H Kuller, J D Neaton
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
Insights
Isolated systolic hypertension (ISH) in older white men significantly increases the risk of death from coronary heart disease and stroke. Systolic blood pressure is a key factor in mortality, warranting further study of ISH treatment.
Area of Science:
- Cardiovascular epidemiology
- Public health
Background:
- The Multiple Risk Factor Intervention Trial (MRFIT) screened a large cohort of white men aged 35-57.
- Hypertension is a major risk factor for cardiovascular events.
Purpose of the Study:
- To examine the relationship between initial blood pressure levels and subsequent coronary heart disease (CHD), stroke, and all-cause mortality.
- To determine the prevalence and impact of isolated systolic hypertension (ISH) in this cohort.
Main Methods:
- Analysis of a large cohort (317,871) of white men screened for MRFIT.
- Statistical examination of blood pressure levels (systolic and diastolic) and mortality outcomes over a 6-year period.
Main Results:
- Isolated systolic hypertension (ISH), defined as SBP ≥ 160 mm Hg and DBP < 90 mm Hg, was present in 0.67% of men and increased with age.
- Men over 50 with ISH had the highest CHD and all-cause mortality rates.
- ISH was associated with a 3.0-fold increased relative risk of death from stroke.
Conclusions:
- Systolic blood pressure is a primary determinant of all-cause and CHD mortality, even at normal diastolic pressure levels.
- ISH poses a significant mortality risk, particularly in older men.
- Further research is needed to understand ISH determinants and treatment efficacy in individuals under 60.
Abstract:
The large cohort of white men (317,871) 35 to 57 years old at initial screening for possible enrollment into the Multiple Risk Factor Intervention Trial (MRFIT) was examined with regard to initial blood pressure levels and subsequent coronary heart disease (CHD), stroke, and all-cause mortality. The overall prevalence of isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg, was 0.67% among white men screened for MRFIT and increased with age (0.31% among 35- to 39-year-olds to 1.7% among 55- to 57-year-olds). The 6 year CHD and all-cause mortality rates in men over 50 were highest in those with ISH compared with both subjects with diastolic hypertension and those with normal pressure. The relative risk of death from stroke in those with ISH, compared with that in those with SBP less than 160 mm Hg and those with DBP less than 90 mm Hg, was 3.0 (95% confidence interval 1.3 to 6.8). In addition, at any level of DBP, the level of SBP appeared to be the major determinant of all-cause and CHD mortality. The determinants of ISH in individuals under 60 years of age as well as the possible efficacy of its treatment should be evaluated further.