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The natural history of borderline isolated systolic hypertension
1Framingham Heart Study, MA 01701.
Insights
Individuals with borderline isolated systolic hypertension face a significantly higher risk of developing definite hypertension and experiencing cardiovascular events. This condition, common in older adults, requires careful monitoring for long-term health.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Isolated systolic hypertension increases cardiovascular risk.
- Borderline isolated systolic hypertension (140-159/ <90 mm Hg) risk requires evaluation.
- Comparison with normotensive individuals (<140/90 mm Hg) is crucial.
Purpose of the Study:
- Assess risk of progression to definite hypertension.
- Evaluate risk of major morbid or fatal cardiovascular events.
- Determine if borderline isolated systolic hypertension poses greater risk than normal blood pressure.
Main Methods:
- Framingham Heart Study participants (n=2767) monitored biennially.
- Follow-up duration up to 34 years.
- Defined definite hypertension and tracked major cardiovascular events.
Main Results:
- Borderline isolated systolic hypertension is common in adults over 60.
- 80% progressed to definite hypertension vs. 45% in normotensive group (P < 0.001).
- Increased long-term risk for cardiovascular disease (HR, 1.47) and cardiovascular death (HR, 1.57). Short-term analysis showed increased risk of hypertension progression (OR, 3.84) and cardiovascular disease (OR, 1.39).
Conclusions:
- Borderline isolated systolic hypertension elevates short-term and long-term risks.
- Increased risk for progression to definite hypertension.
- Increased risk for developing cardiovascular disease.
Background:
Patients with isolated systolic hypertension are at increased risk for cardiovascular disorders. We attempted to determine whether those with borderline isolated systolic hypertension (defined as a systolic blood pressure of 140 to 159 mm Hg and a diastolic blood pressure below 90 mm Hg) have a greater risk of progression to definite (more severe) hypertension and of major morbid or fatal events than people with normal blood pressure (< 140/90 mm Hg).
Methods:
A total of 2767 of the original participants in the Framingham Heart Study were monitored with biennial examinations for up to 34 years for the development of definite hypertension (defined as a systolic blood pressure of > or = 160 mm Hg, a diastolic blood pressure of > or = 90 mm Hg, or the initiation of antihypertensive therapy) and for major cardiovascular events.
Results:
Borderline isolated systolic hypertension was the most common type of untreated hypertension among adults over the age of 60. After 20 years of follow-up, 80 percent of those with borderline isolated systolic hypertension had progression to definite hypertension, as compared with 45 percent of the normotensive participants (P < 0.001). After adjustment for age, sex, and risk factors for cardiovascular disease, participants with borderline isolated systolic hypertension had an excess long-term risk of cardiovascular disease (hazard ratio, 1.47; 95 percent confidence interval, 1.24 to 1.74) and death from cardiovascular disease (hazard ratio, 1.57; 95 percent confidence interval, 1.24 to 2.00), as compared with normotensive participants. In an analysis of pooled data from biennial examinations to study short-term sequelae, subjects with borderline isolated systolic hypertension had an increased risk of progression to definite hypertension (odds ratio, 3.84; 95 percent confidence interval, 3.35 to 4.41) and of cardiovascular disease (odds ratio, 1.39; 95 percent confidence interval, 1.06 to 1.82).
Conclusions:
In both the short term and the long term, subjects with borderline isolated systolic hypertension are at increased risk of progression to definite hypertension and the development of cardiovascular disease.