Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study

Background: Isolated systolic hypertension and isolated diastolic hypotension are common in older adults and associated with a higher risk of incident heart failure (HF). However, little is known about the prevalence and impact of isolated diastolic hypertension in this population. Methods: In the Cardiovascular Health Study (CHS), of the 5776 community-dwelling older adults >= 65 years who had data on baseline systolic and diastolic blood pressure (SBP and DBP), 28 had isolated diastolic hypertension (DBP >= 90 mm Hg and SBP < 140 mm Hg). From the 5748 without isolated diastolic hypertension, we excluded those with SBP >= 120 mm Hg (n = 4451), DBP 80-89 mm Hg (n = 20), DBP < 60 mm Hg (n = 425), normal BP taking anti-hypertensive medications (n = 311), normal BP taking no anti-hypertensive medications but with history of hypertension (n = 38), and baseline HF (n = 5). The final cohort of 524 participants included 27 with isolated diastolic hypertension. Results: Patients (n = 524) had a mean (+/- SD) age of 71 (+/- 5) years, 58% were women and 9% African American. There were no significant between-group age or sex differences; 37% of those with isolated diastolic hypertension (versus 7% without) were African American. Incident HF occurred in 19% and 7% of participants with and without isolated diastolic hypertension, respectively (multivariable-adjusted hazard ratio {HR}, 4.65; 95% confidence interval {CI}, 1.09-19.90; p = 0.038). There was a trend toward higher cardiovascular mortality (HR, 4.59; 95% CI, 0.92-23.88; p = 0.063). Conclusion: Among community-dwelling older adults, isolated diastolic hypertension is rare and is associated with higher risk for incident HF and cardiovascular mortality. Published by Elsevier Ireland Ltd.