Aging, Blood Pressure, and Heart Failure

Abstract

See related article, pp 895–901 Although systolic blood pressure (BP; SBP) is the best predictor of future cardiovascular disease (CVD) risk for the majority of the older hypertensive population, there is much that can be learned from simultaneously assessing diastolic BP (DBP) and its relation to levels of SBP.1 After 50 years of age, SBP increases disproportionately to DBP, and after 60 years of age DBP falls, resulting in a widening of the pulse pressure (PP).1 Indeed, a previous Framingham Heart Study report revealed an age-related gradual shift from DBP below 50 years of age to SBP and PP at older ages as predictors of coronary heart disease risk.2 Furthermore, with the age-related rise in SBP and fall in DBP, isolated SBP (ISH), accompanied by a wide PP, becomes the most common form of hypertension from middle-aged onward3 and is associated with increased CVD risk in general4 and overt heart failure in particular.5 ### The Role of Low DBP as a Predictor of CVD Risk With Aging In Framingham Heart Study participants who were free of CVD and not receiving BP-lowering therapy, SBP and DBP (or mean arterial pressure and PP) in combination produced a model that was superior to any single BP component alone in predicting total CVD events (coronary heart disease, heart failure, and stroke)6; of the 4 BP components, only DBP was nonlinear and showed a J-shaped curve of CVD risk that could be related to a rise in PP and/or a fall in DBP, and these findings were independent of antihypertensive therapy. Furthermore, when CVD events were stratified by DBP <70 mm Hg versus ≥70 to 89 mm Hg to evaluate risk according to the Sixth Joint National Committee classification, those individuals with DBP <70 mm Hg had an increased cardiovascular event rate (Table).6 Importantly, data from the …