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(Hypertension. 2001;38:1372.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Cardiac and Vascular Remodeling in Older Adults With Borderline Isolated Systolic Hypertension

The ICARe Dicomano Study

Riccardo Pini; M. Chiara Cavallini; Francesca Bencini; Loredana Staglianò; Elisabetta Tonon; Francesca Innocenti; Giorgio Baldereschi; Niccolò Marchionni; Mauro Di Bari; Richard B. Devereux; Giulio Masotti; Mary J. Roman

From the Department of Critical Care Medicine and Surgery-Unit of Gerontology and Geriatrics, University of Firenze, Firenze, Italy, the Azienda Ospedaliera Careggi, Firenze, Italy; and the Department of Medicine, New York Presbyterian Hospital-Weill Medical College of Cornell University (R.B.D., M.J.R.).

Correspondence to Riccardo Pini, MD, Unit of Gerontology and Geriatrics, Via delle Oblate 4, 50141 Firenze, Italy. E-mail: rpini{at}unifi.it

Although borderline isolated systolic hypertension (ISH), defined as a blood pressure of 140 to 159/<90 mm Hg, is a proven cardiovascular risk factor, the major clinical trials on treatment of ISH have used a cutoff of 160 mm Hg. Moreover, no data exist on the cardiovascular modifications associated with borderline ISH. Therefore, we compared subjects with borderline ISH to subjects with diastolic hypertension (diastolic blood pressure 90 mm Hg) or ISH. Community-dwelling residents (age 65 years) of a small town in Italy (Dicomano) underwent extensive clinical examination, echocardiography, carotid ultrasonography, and applanation tonometry. Only untreated subjects were included in this analysis: 95 with diastolic hypertension, 87 with borderline ISH, and 43 with ISH. Despite lower systolic and mean pressures in borderline ISH, left ventricular mass was similar to that in diastolic hypertension. In univariate and multivariate analysis, pulse pressure but not systolic pressure was related to left ventricular mass. Borderline ISH subjects had a tendency to greater carotid cross-sectional area and stiffness index than did diastolic hypertensive subjects despite lower mean carotid pressure, whereas the number of atherosclerotic plaques was similar in the 2 groups. Pulse pressure but not systolic pressure was independently related to carotid remodeling. In our community-based, older population, individuals with borderline ISH had a similar prevalence of left ventricular hypertrophy and carotid atherosclerosis as that of subjects with diastolic hypertension, despite lower systolic and mean pressures. Among blood pressure values, pulse pressure was the single or strongest independent predictor of cardiovascular remodeling.

Key Words: age • carotid arteries • atherosclerosis • arterial compliance • hypertrophy

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