Background Patients with isolated systolic hypertension areat increased risk for cardiovascular disorders. We attemptedto determine whether those with borderline isolated systolichypertension (defined as a systolic blood pressure of 140 to159 mm Hg and a diastolic blood pressure below 90 mm Hg) havea greater risk of progression to definite (more severe) hypertensionand of major morbid or fatal events than people with normalblood pressure (<140/90 mm Hg).
Methods A total of 2767 of the original participants in theFramingham Heart Study were monitored with biennial examinationsfor up to 34 years for the development of definite hypertension(defined as a systolic blood pressure of 160 mm Hg, a diastolicblood pressure of 90 mm Hg, or the initiation of antihypertensivetherapy) and for major cardiovascular events.
Results Borderline isolated systolic hypertension was the mostcommon type of untreated hypertension among adults over theage of 60. After 20 years of follow-up, 80 percent of thosewith borderline isolated systolic hypertension had progressionto definite hypertension, as compared with 45 percent of thenormotensive participants (P<0.001). After adjustment forage, sex, and risk factors for cardiovascular disease, participantswith borderline isolated systolic hypertension had an excesslong-term risk of cardiovascular disease (hazard ratio, 1.47;95 percent confidence interval, 1.24 to 1.74) and death fromcardiovascular disease (hazard ratio, 1.57; 95 percent confidenceinterval, 1.24 to 2.00), as compared with normotensive participants.In an analysis of pooled data from biennial examinations tostudy short-term sequelae, subjects with borderline isolatedsystolic hypertension had an increased risk of progression todefinite hypertension (odds ratio, 3.84; 95 percent confidenceinterval, 3.35 to 4.41) and of cardiovascular disease (oddsratio, 1.39; 95 percent confidence interval, 1.06 to 1.82).
Conclusions In both the short term and the long term, subjectswith borderline isolated systolic hypertension are at increasedrisk of progression to definite hypertension and the developmentof cardiovascular disease.
Source Information
From the Framingham Heart Study, Framingham, Mass. (A.S., M.G.L., D.L.); the National Heart, Lung, and Blood Institute, Bethesda, Md. (M.G.L., D.L.); the Divisions of Epidemiology and Preventive Medicine, Boston University School of Medicine, Boston (D.L.); and the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Boston (D.L.). Dr. Sagie was a visiting Research Fellow from Beilinson Medical Center, Petah Tikva, Israel, and the Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.Presented at the 66th Scientific Sessions of the American Heart Association, November 8-11, 1993.
Address reprint requests to Dr. Levy at the Framingham Heart Study, 5 Thurber St., Framingham, MA 01701.
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