ABSTRACT
In a community survey of 3242 subjects, 1663 did not initially have isolated systolic hypertension (ISH) and were re-screened an average of 8 years later. ISH developed in 53 (22%) of untreated patients with previous diastolic hypertension. Similarly, 8% of subjects with transient hypertension and 8% of normotensive controls developed ISH. Of all cases of ISH, 16% had previous diastolic hypertension. These subjects were more likely to have continued to smoke (P = 0.01) and lost more weight (P = 0.001) than patients with ISH who did not have burned-out diastolic hypertension.
Subject(s)
Hypertension/physiopathology , Adolescent , Adult , Aged , Aging/physiology , Antihypertensive Agents/therapeutic use , Body Weight , Chronic Disease , Diastole/physiology , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged , Prevalence , Prognosis , Risk Factors , Smoking , Systole/physiologyABSTRACT
Casual readings of blood pressure predict mortality and may reflect either the risk of sustained hypertension, additional components of 'white coat' hypertension or variable blood pressure. This study investigated mortality in 442 men and 360 women with a diastolic pressure (Phase IV) of 90 mmHg and over, unsustained on two subsequent monthly visits, followed for an average of 11 years and compared with a matched control cohort with an initial diastolic pressure (DBP) of less than 90 mmHg. Subjects were identified between 1975 and 1979 by screening 28,257 subjects aged 18-65 years on the lists of general practitioners in seven practices in the United Kingdom. Additionally, 912 men and 844 women with sustained hypertension (DBP > 90 mmHg on at least two out of three occasions) were identified and matched with normotensive controls. In men with sustained hypertension the relative risk (RR) for death from circulatory disease was 1.76, P < 0.01, 95% confidence interval 1.21, 2.58 and in women 1.85, P < 0.05, 95% confidence interval 1.06, 3.24 respectively, while in men with unsustained hypertension the RR = 1.52, P = 0.2, 95% confidence interval 0.81, 2.84. Few circulatory deaths occurred in women with transient hypertension or their controls (five and seven respectively). Despite the screening programme and further treatment, newly discovered subjects with sustained hypertension, both men and women, remain at high risk of cardiovascular mortality. The 95% confidence interval for men with transient hypertension does not exclude a similar adverse effect.