The Natural History of Borderline Isolated Systolic Hypertension

Patients with isolated systolic hypertension are at increased risk for cardiovascular disorders. We attempted to determine whether those with borderline isolated systolic hypertension (defined as a systolic blood pressure of 140 to 159 mm Hg and a diastolic blood pressure below 90 mm Hg) have a greater risk of progression to definite (more severe) hypertension and of major morbid or fatal events than people with normal blood pressure (<140/90 mm Hg). A total of 2767 of the original participants in the Framingham Heart Study were monitored with biennial examinations for up to 34 years for the development of definite hypertension (defined as a systolic blood pressure of ≤ 160 mm Hg, a diastolic blood pressure of ≤ 90 mm Hg, or the initiation of antihypertensive therapy) and for major cardiovascular events. Borderline isolated systolic hypertension was the most common type of untreated hypertension among adults over the age of 60. After 20 years of follow-up, 80 percent of those with borderline isolated systolic hypertension had progression to definite hypertension, as compared with 45 percent of the normotensive participants (P<0.001). After adjustment for age, sex, and risk factors for cardiovascular disease, participants with borderline isolated systolic hypertension had an excess long-term risk of cardiovascular disease (hazard ratio, 1.47; 95 percent confidence interval, 1.24 to 1.74) and death from cardiovascular disease (hazard ratio, 1.57; 95 percent confidence interval, 1.24 to 2.00), as compared with normotensive participants. In an analysis of pooled data from biennial examinations to study short-term sequelae, subjects with borderline isolated systolic hypertension had an increased risk of progression to definite hypertension (odds ratio, 3.84; 95 percent confidence interval, 3.35 to 4.41) and of cardiovascular disease (odds ratio, 1.39; 95 percent confidence interval, 1.06 to 1.82). In both the short term and the long term, subjects with borderline isolated systolic hypertension are at increased risk of progression to definite hypertension and the development of cardiovascular disease., Hypertension is an important contributor to the morbidity and mortality of cardiovascular disease¹. There is compelling evidence that systolic blood pressure is at least as important a determinant of the risk of cardiovascular disease as diastolic blood pressure²–⁶. The prevalence of isolated systolic hypertension, defined as a systolic blood pressure of 160 mm Hg or more and a diastolic blood pressure of less than 90 mm Hg, increases with age, affecting up to 30 percent of people over 60 years of age⁶,⁷. Patients with isolated systolic hypertension are at substantially increased risk for stroke, coronary…