Systolic Blood Pressure and Incident Heart Failure in the Elderly

• Type of Material: Article
• Authors: Javed Butler, Emory University; Andreas Kalogeropoulos, Emory University; Vasiliki (Vicki) Georgiopoulou, Emory University; Kirsten Bibbins-Domingo, University of California, San Francisco; Samer S. Najjar, MedStar Health Research Institute; Kim C. Sutton-Tyrrell, University of Pittsburgh; Tamara B. Harris, National Institutes of Health; Stephen B. Kritchevsky, Wake Forest University; Donald M. Lloyd-Jones, Northwestern University; Anne B. Newman, University of Pittsburgh; Bruce M. Psaty, University of Washington
• Language: English
• Date: 2011-08
• Publisher: BMJ Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011, BMJ Publishing Group Ltd and the British Cardiovascular Society
• Final Published Version (URL): http://heart.bmj.com/content/97/16/1304
• Title of Journal or Parent Work: Heart
• ISSN: 1355-6037
• Volume: 97
• Issue: 16
• Start Page: 1304
• End Page: 1311
• Grant/Funding Information: This research was also supported in part by the Intramural Research Program of the NIH, National Institute on Aging, by an Emory University Heart and Vascular Board grant entitled ‘Novel Risk Markers and Prognosis Determination in Heart Failure’, and by PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, NIH, National Center for Research Resources.; This research was supported by contract numbers N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, grant U01 HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke (Cardiovascular Health Study), and contract numbers N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106 from the National Institute of Aging (Health ABC Study).
• Keywords: hypertension; risk stratification; heart failure; epidemiology
• Research Categories: Gerontology; Health Sciences, Epidemiology

Abstract

Objectives 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 medications. Our aim was to examine the association between SBP and HF risk in the elderly. Design Competing-risks proportional hazards modeling of incident HF risk, utilizing 10-year follow-up data from two NIH-sponsored cohort studies; the Cardiovascular Health Study (inception: 1989-90 and 1992-93) and the Health ABC Study (inception: 1997-98). 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 medications at baseline. Main outcome measures Incident HF, defined as first adjudicated hospitalisation for HF. Results Over 10 years, 493 (11.1%) participants developed HF. Prehypertension (120-139 mmHg), stage 1 (140-159 mmHg), and stage 2 (≥160 mmHg) hypertension were associated with escalating HF risk; hazard ratios vs. optimal SBP (<120 mmHg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI, 1.23-2.16; P=0.001), 2.21 (95% CI, 1.65-2.96; P<0.001), and 2.60 (95% CI, 1.85-364; P<0.001), respectively. Overall 255 of 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 men; no race-SBP interaction was observed. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mmHg in men and 112 mmHg 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 mmHg; over half of incident HF events occur in individuals with SBP <140 mmHg.