ISOLATED SYSTOLIC HYPERTENSION AND SUBCLINICAL CARDIOVASCULAR-DISEASE IN THE ELDERLY - INITIAL FINDINGS FROM THE CARDIOVASCULAR HEALTH STUDY

Objective.-To assess the association between isolated systolic hypertension (ISH) and subclinical disease in adults aged 65 years and above. Design.-Medicare eligibility lists were used to obtain a representative sample of 5201 community-dwelling elderly persons for the Cardiovascular Health Study, a National Heart, Lung, and Blood Institute-sponsored cohort study of risk factors for coronary heart disease and stroke. In this cross-sectional analysis of baseline data, we excluded 3012 participants who were receiving antihypertensive medications, had clinical cardiovascular disease, or had a diastolic blood pressure of at least 90 mm Hg. Main Outcome Measures.-For electrocardiogram: myocardial infarction, left ventricular hypertrophy, and left ventricular mass as measures of myocardial damage and strain; for echocardiography: left ventricular mass, fractional shortening, and Doppler flow velocities as measures of cardiac systolic and diastolic function; and for carotid sonography: carotid arterial intima-media thickness as a measure of atherosclerosis. Results.-Among the 2189 men and women in this analysis, 195 (9%) had ISH (systolic blood pressure, greater-than-or-equal-to 160 mm Hg) and 596 (23%) had borderline ISH (systolic blood pressure, 140 to 159 mm Hg). Systolic blood pressure was associated with myocardial infarction by electrocardiogram (P=.02). Borderline and definite ISH were strongly associated with left ventricular mass (P<.001). While there was little association with cardiac systolic function, borderline and definite ISH were associated with cardiac diastolic function (P<.001). Isolated systolic hypertension was also strongly associated with increased intima-media thickness of the carotid artery (P<.001). Conclusions.-While cohort analyses of future repeated measures will provide a better assessment of risk, both borderline and definite ISH were strongly related to a variety of measures of subclinical disease in elderly men and women.