Influence of Blood Pressure and Blood Pressure Change on the Risk of Congestive Heart Failure in the Elderly

Background: While elevated blood pressure (BP) has been consistently associated with incident congestive heart failure (CHF), much less is known about the effect of BP change. We therefore assessed the association of BP change over time with subsequent risk of CHF.

Methods: 4655 participants >/=65 years old from the prospective Established Populations for Epidemiologic Studies of the Elderly program who were alive and free of CHF after six years of follow-up were included. Categories of sustained high BP, sustained low BP, BP progression and BP regression were defined according to BP differences between study entry and six years of follow-up. The primary endpoint was incident CHF subsequent to the six year examination.

Results: During 4.3 years of follow-up after the six year examination, 642 events occurred. The hazard ratio (HR) (95% confidence interval (CI)) for systolic BP > or =160 compared to <120 mm Hg at six years was 1.39 (1.04-1.86). Conversely, the lowest diastolic BP category at six years was associated with an increased risk of incident CHF (HR (95% CI) <70 mm Hg versus 70-79 mm Hg 1.42 (1.18-1.71)). Systolic and diastolic BP were better predictors than pulse pressure. The HRs (95% CI) for incident CHF associated with sustained high systolic BP > or =160 mm Hg and systolic BP progression were 1.35 (0.97-1.89) and 1.45 (1.14-1.85), respectively. Conversely, significant associations were found in those with sustained low diastolic BP or diastolic BP regression (HR (95% CI) 1.42 (1.11-1.83) and 1.45 (1.19-1.76), respectively).

Conclusion: While persistently elevated systolic BP and systolic BP progression were strong predictors of CHF in the elderly, inverse associations were found with regard to diastolic BP. Systolic and diastolic BP were better predictors of CHF than pulse pressure.