@article {1294, title = {Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study.}, journal = {Heart}, volume = {97}, year = {2011}, month = {2011 Aug}, pages = {1304-11}, abstract = {

BACKGROUND: The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs.

OBJECTIVE: To examine the association between SBP and HF risk in the elderly.

DESIGN: Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989-90 and 1992-3) and the Health ABC Study (inception: 1997-8).

SETTING: Community-based cohorts.

PARTICIPANTS: 4408 participants (age, 72.8 (4.9) years; 53.1\% women, 81.7\% white; 18.3\% black) without prevalent HF and not receiving antihypertensive drugs at baseline.

MAIN OUTCOME MEASURES: Incident HF, defined as first adjudicated hospitalisation for HF.

RESULTS: Over 10 years, 493 (11.2\%) participants developed HF. Prehypertension (120-139 mm Hg), stage 1 (140-159 mm Hg), and stage 2 (>=160 mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (<120 mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 (95\% CI 1.23 to 2.16; p=0.001), 2.21 (95\% CI 1.65 to 2.96; p<0.001) and 2.60 (95\% CI 1.85 to 3.64; p<0.001), respectively. Overall 255/493 (51.7\%) HF events occurred in participants with SBP <140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race-SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women.

CONCLUSIONS: There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mm Hg; over half of incident HF events occur in individuals with SBP <140 mm Hg.

}, keywords = {Aged, Aged, 80 and over, Aging, Blood Pressure, Body Composition, Epidemiologic Methods, Female, Heart Failure, Humans, Hypertension, Male, Myocardial Infarction, Sex Factors, Stroke, Stroke Volume}, issn = {1468-201X}, doi = {10.1136/hrt.2011.225482}, author = {Butler, Javed and Kalogeropoulos, Andreas P and Georgiopoulou, Vasiliki V and Bibbins-Domingo, Kirsten and Najjar, Samer S and Sutton-Tyrrell, Kim C and Harris, Tamara B and Kritchevsky, Stephen B and Lloyd-Jones, Donald M and Newman, Anne B and Psaty, Bruce M} }