Abstract 13669: Hypertension Subtypes as Predictors of Cardiovascular and All-Cause Mortality

Background: While hypertensive subtypes have been examined in relation to cardiovascular disease (CVD) outcomes in selected earlier cohorts, noting poorer outcomes in those with isolated systolic hypertension (ISH) in particular, contemporary data utilizing newer definitions of hypertension are lacking among US population-representative adults. We evaluated the association between hypertension subtypes with CVD and all-cause mortality.

Methods: We included data from the National Health and Nutrition Examination Survey (NHANES) dataset 1999-2008 with follow-up through 2018. Hypertensive subtypes were based on systolic and diastolic blood pressure cut points of 130 and 80 mmHg, respectively. The incidence of CVD and all-cause mortality was examined and compared between hypertension subtypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]) against patients with normal blood pressure using Cox regression analysis, adjusted for age, ethnicity, gender, tobacco use, use of antihypertensive agents, and comorbidities including diabetes mellitus and dyslipidemia.

Results: A total of 23,206 subjects (projected to 194 million US adults) were included at baseline, of which 58% were normotensive, 21% had ISH, 8% had IDH, and 13% had SDH. In the adjusted analysis, ISH and SDH (but not IDH) were significantly associated with increased CVD. Subgroup analyses excluding those not on antihypertensive therapy (26.8%) showed these relationships to persist, except for ISH in relation to CVD mortality.

Conclusions: Compared to normotension, ISH and SDH were independently associated with higher risk of cardiovascular and all-cause mortality. This has important implications for the continued necessity of managing systolic hypertension.