Original Investigation
Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality: The Chicago Heart Association Detection Project in Industry Study

https://doi.org/10.1016/j.jacc.2014.10.060Get rights and content
Under an Elsevier user license
open archive

Abstract

Background

Isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, in younger and middle-aged adults is increasing in prevalence.

Objective

The aim of this study was to assess the risk for cardiovascular disease (CVD) with ISH in younger and middle-aged adults.

Methods

CVD risks were explored in 15,868 men and 11,213 women 18 to 49 years of age (mean age 34 years) at baseline, 85% non-Hispanic white, free of coronary heart disease (CHD) and antihypertensive therapy, from the Chicago Heart Association Detection Project in Industry study. Participant classifications were as follows: 1) optimal-normal blood pressure (BP) (SBP <130 mm Hg and DBP <85 mm Hg); 2) high-normal BP (130 to 139/85 to 89 mm Hg); 3) ISH; 4) isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg); and 5) systolic diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg).

Results

During a 31-year average follow-up period (842,600 person-years), there were 1,728 deaths from CVD, 1,168 from CHD, and 223 from stroke. Cox proportional hazards models were adjusted for age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men, with optimal-normal BP as the reference stratum, hazard ratios for CVD and CHD mortality risk for those with ISH were 1.23 (95% confidence interval [CI]: 1.03 to 1.46) and 1.28 (95% CI: 1.04 to 1.58), respectively. ISH risks were similar to those with high-normal BP and less than those associated with isolated diastolic hypertension and systolic diastolic hypertension. In women with ISH, hazard ratios for CVD and CHD mortality risk were 1.55 (95% CI: 1.18 to 2.05) and 2.12 (95% CI: 1.49 to 3.01), respectively. ISH risks were higher than in those with high-normal BP or isolated diastolic hypertension and less than those associated with systolic diastolic hypertension.

Conclusions

Over long-term follow-up, younger and middle-aged adults with ISH had higher relative risk for CVD and CHD mortality than those with optimal-normal BP.

Key Words

cardiovascular risk
long-term follow-up
younger adults

Abbreviations and Acronyms

BMI
body mass index
BP
blood pressure
CHA
Chicago Heart Association Detection Project in Industry
CHD
coronary heart disease
CI
confidence interval
CVD
cardiovascular disease
DBP
diastolic blood pressure
HR
hazard ratio
ICD-8
International Classification of Diseases-Eighth Revision
ICD-9
International Classification of Diseases-Ninth Revision
IDH
isolated diastolic hypertension
ISH
isolated systolic hypertension
SBP
systolic blood pressure
SDH
systolic diastolic hypertension

Cited by (0)

This study was supported by the American Heart Association and its Chicago and Illinois affiliates; grants R01-HL 15174, R01-HL 21010, and R01-HL 03387 from the National Heart, Lung, and Blood Institute; the Northwestern Memorial Foundation; and the Goldberg Family Charitable Trust. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

You can also listen to this issue's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.