Isolated systolic hypertension conferred higher mortality risk in young adults

Isolated systolic hypertension during young and middle age was associated with increased long-term risk for death related to CVD and CHD compared with optimal BP.

Researchers analyzed 15,868 men and 11,213 women from the Chicago Heart Association Detection Project in Industry study (85% non-Hispanic white) who were recruited from 1967 to 1973. The participants were aged 18 to 49 years and free from CHD or antihypertensive therapy at baseline.

Participants were stratified by BP classification:

optimal-normal, defined as systolic BP <130 mm Hg/diastolic BP <85 mm Hg;
high-normal BP, defined as systolic BP 130 mm Hg to 139 mm Hg/diastolic BP 85 mm Hg to 89 mm Hg;
isolated systolic hypertension, defined as systolic BP ≥140 mm Hg/diastolic BP <90 mm Hg;
isolated diastolic hypertension, defined as systolic BP <140 mm Hg/diastolic BP ≥90 mm Hg; or
systolic diastolic hypertension, defined as systolic BP ≥140 mm Hg/diastolic BP ≥90 mm Hg.

During a mean 31-year follow-up period covering 842,600 person-years, 1,728 deaths from CVD, 1,168 deaths from CHD and 223 deaths from stroke occurred.

Higher risk for mortality

Compared with men with optimal normal BP at baseline, men with isolated systolic hypertension at baseline had an increased risk for CVD mortality (HR=1.23; 95% CI, 1.03-1.46) and for CHD mortality (HR=1.28; 95% CI, 1.04-1.58), after researchers adjusted for age, race, education, BMI, current smoking, total cholesterol and diabetes. The elevated risk was similar to that of men with high-normal BP and less than that of men with isolated diastolic hypertension and systolic diastolic hypertension, according to the results.

Likewise, after the same adjustments, women with isolated systolic hypertension at baseline had an increased risk for CVD mortality (HR=1.55; 95% CI, 1.18-2.05) and for CHD mortality (HR=2.12; 95% CI, 1.49-3.01) compared with women with optimal-normal BP at baseline. The elevated risk was higher than that of women with high-normal BP or isolated diastolic hypertension and less than that of women with systolic diastolic hypertension, the researchers wrote.

“Until now, physicians have not considered isolated systolic hypertension to be bad, but this study shows higher risk,” Yuichiro Yano, MD, PhD, from the department of preventive medicine at Northwestern University Feinberg School of Medicine, said in a press release. “By identifying risks in younger populations, they can be made aware of the need to maintain [CV] health as they age.”

Therapy needed

Michael A. Weber

In a related editorial, Michael A. Weber, MD, from the division of cardiovascular medicine at the State University of New York, Downstate College of Medicine, Brooklyn, N.Y., wrote that because individuals with isolated systolic hypertension also had higher diastolic BP than those with optimal-normal BP, it is difficult to determine if systolic BP and diastolic BP are independent determinants of outcomes, but “elevated systolic or diastolic BP or both should clearly be considered abnormal in young adults and lead to therapy.”

Weber, a member of Cardiology Today’s Editorial Board, noted that “the growing prevalence of hypertension, along with obesity, lipid disorders and diabetes, in young people has become a major health issue. Indeed, it is to be hoped that early management of hypertension in young adults might beneficially alter its natural history and reduce the incidence of [CV] events later in life.”

For more information:

Weber MA. J Am Coll Cardiol. 2015;65:336-338.

Yano Y. J Am Coll Cardiol. 2015;65:327-335.

Disclosure: The researchers and Weber report no relevant financial disclosures.