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Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study.
Tuesday,2012-11-06 12:25 America/Los_Angeles — eenright
| Title | Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study. |
| Publication Type | Journal Article |
| Year of Publication | 2011 |
| Authors | Butler, J, Kalogeropoulos, AP, Georgiopoulou, VV, Bibbins-Domingo, K, Najjar, SS, Sutton-Tyrrell, KC, Harris, TB, Kritchevsky, SB, Lloyd-Jones, DM, Newman, AB, Psaty, BM |
| Journal | Heart |
| Volume | 97 |
| Issue | 16 |
| Pagination | 1304-11 |
| Date Published | 2011 Aug |
| ISSN | 1468-201X |
| 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 |
| Abstract | <p><b>BACKGROUND: </b>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.</p><p><b>OBJECTIVE: </b>To examine the association between SBP and HF risk in the elderly.</p><p><b>DESIGN: </b>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).</p><p><b>SETTING: </b>Community-based cohorts.</p><p><b>PARTICIPANTS: </b>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.</p><p><b>MAIN OUTCOME MEASURES: </b>Incident HF, defined as first adjudicated hospitalisation for HF.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1136/hrt.2011.225482 |
| Alternate Journal | Heart |
| PubMed ID | 21636845 |
| PubMed Central ID | PMC3652313 |
| Grant List | UL1 TR000005 / TR / NCATS NIH HHS / United States N01-AG-6-2101 / AG / NIA NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-AG-6-2103 / AG / NIA NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States / / Intramural NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States UL1 TR000454 / TR / NCATS NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01-AG-6-2106 / AG / NIA NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States UL1 RR025008 / RR / NCRR NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States |