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(Hypertension. 1995;26:377-382.)
© 1995 American Heart Association, Inc.
Articles |
Isolated Diastolic Hypertension
A Favorable Finding Among Young and Middle-aged Hypertensive Subjects
From the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
Abstract To identify pretreatment characteristics associated
with subsequent myocardial infarction in young and middle-aged
previously untreated hypertensive individuals, we examined the
experience of 1560 participants in a work-site hypertension control
program who were younger than 60 years. Subjects were categorized by
initial blood pressure as having isolated diastolic
hypertension (<160/
90 mm Hg, n=965) or combined systolic and
diastolic hypertension (160/90 mm Hg, n=595). During
4.5 years of follow-up, there were 24 myocardial infarctions, yielding
an overall incidence of 3.89 per 1000 person-years. Subjects with
systolic/diastolic hypertension were older, had higher
cholesterol and blood sugar levels, and included more
smokers and people with left ventricular
hypertrophy on electrocardiogram than those
with isolated diastolic hypertension. Age-adjusted
incidence rates for myocardial infarction were 5.20 and 2.21 per 1000
person-years in systolic/diastolic hypertension and
isolated diastolic hypertension, respectively, and the
relative risk of systolic/diastolic hypertension was 2.31
(95% confidence interval, 1.29-4.15). Among subjects with isolated
diastolic hypertension, no myocardial infarction occurred
in those with systolic pressure less than 140 mm Hg. Cox regression
analysis including other known risk factors showed that pulse
pressure, as a continuous variable (hazards ratio, 1.54; 95%
confidence interval, 1.08-2.20), and type of hypertension, ie,
systolic/diastolic hypertension versus isolated
diastolic hypertension (hazards ratio, 2.11; 95%
confidence interval, 1.08-4.13), were independently associated with
myocardial infarction. These results suggest that young and middle-aged
treated hypertensive individuals with normal pretreatment systolic
pressure enjoy a more favorable prognosis than do those with systolic
elevation. This data, based on the outcomes of treated subjects, cannot
be extrapolated to define what the experience of individuals with
isolated diastolic hypertension might be in the absence of
drug therapy.
Key Words: risk factors • young and middle-aged • myocardial infarction • blood pressure
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