Introduction: Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk.
Hypothesis: ISH and CH may have different predictive role for the incidence of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients.
Methods: We followed up 1605 essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 58.1 years, 842 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP <90 mmHg, while those with CH had office systolic BP ≥140 mmHg and office diastolic BP ≥90 mmHg. Moreover, CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure, while stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging.
Results: The incidence of CAD and stroke over the follow-up period was 3.1% (n=50) and 1.4% (n=22) respectively. Patients with ISH (n=510) compared to those with Cη (n=1095) were older (65±10 vs 55±11 years, p<0.0001), had at baseline lower waist circumference (95.5±12 vs 98±12 cm, p<0.0001), and office systolic BP (149±10 vs 155±13 mmHg, p<0.0001), while did not differ regarding left ventricular mass index and lipid levels (p=NS for all). In multivariate Cox regression model baseline glomerular filtration rate (hazard ratio=1.019, p=0.015), left ventricular mass index (hazard ratio=1.011, p=0.022) and ISH (hazard ratio=1.875, p=0.018) but not CH turned out to be independent predictors of CAD, while ISH (hazard ratio=1.243, p=0.019) and CH (hazard ratio=1.132, p=0.031) predicted stroke.
Conclusions: Both ISH and CH predict future development of stroke, whereas ISH but not CH exhibits independent prognostic value for CAD, suggesting different predictive role of ISH and CH for the cerebrovascular and coronary events.