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(Hypertension. 2001;37:869.)
© 2001 American Heart Association, Inc.
Scientific Contribution |
Predominance of Isolated Systolic Hypertension Among Middle-Aged and Elderly US Hypertensives
Analysis Based on National Health and Nutrition Examination Survey (NHANES) III
From the Heart Disease Prevention Program, University of California, Irvine (S.S.F., M.J.J., N.D.W.), and Bristol-Myers Squibb, Pharmaceutical Research Institute, Princeton, NJ (G.J.L., P.L.).
Correspondence and reprint requests to Dr Stanley S. Franklin, Heart Disease Prevention Program, C240 Medical Sciences, University of California, Irvine, CA 92697.
The
purpose of the present study was to examine patterns of
systolic and diastolic hypertension by age in the
nationally representative National Health and Nutrition
Examination Survey (NHANES) III and to determine when treatment and
control efforts should be recommended. Percentage distribution of 3
blood pressure subtypes (isolated systolic hypertension,
combined systolic/diastolic hypertension, and
isolated diastolic hypertension) was categorized for
uncontrolled hypertension (untreated and inadequately treated) in 2 age
groups (ages <50 and 
50 years). Overall, isolated systolic
hypertension was the most frequent subtype of uncontrolled hypertension
(65%). Most subjects with hypertension (74%) were 50 years of age,
and of this untreated older group, nearly all (94%) were accurately
staged by systolic blood pressure alone, in contrast to
subjects in the untreated younger group, who were best staged by
diastolic blood pressure. Furthermore, most subjects (80%)
in the older untreated and the inadequately treated groups had isolated
systolic hypertension and required a greater reduction in
systolic blood pressure than in the younger groups (-13.3 and
-16.5 mm Hg versus -6.8 and -6.1 mm Hg, respectively;
P=0.0001) to attain a
systolic blood pressure treatment goal of <140 mm Hg.
Contrary to previous perceptions, isolated systolic
hypertension was the majority subtype of uncontrolled hypertension in
subjects of ages 50 to 59 years, comprised 87% frequency for subjects
in the sixth decade of life, and required greater reduction in
systolic blood pressure in these subjects to reach treatment
goal compared with subjects in the younger group. Better awareness of
this middle-aged and older high-risk group and more aggressive
antihypertensive therapy are necessary to address this treatment
gap.
Key Words: hypertension, essential • blood pressure • clinical trials • hypertension, systolic, isolated
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