Blood pressure and isolated systolic hypertension and the risk of coronary heart disease and mortality in elderly men (the Zutphen Elderly Study)

OBJECTIVE: To investigate the associations of diastolic blood pressure (DBP) and systolic blood pressure (SBP) with the risk of coronary heart disease, sudden cardiac and all-cause death in elderly men. DESIGN: A cohort study. SETTING: The Dutch town of Zutphen. SUBJECTS: Eight hundred and eighty-five randomly selected men, aged 64-84 years. MAIN OUTCOME MEASURES: Relative risks adjusted for age, body mass index, total and high-density lipoprotein cholesterol, cigarette smoking, alcohol consumption, use of blood pressure-lowering medications without a specific indication for hypertension, and the physician who measured the blood pressure. RESULTS: Neither DBP nor SBP was associated significantly with the incidence of a first coronary heart disease event and no clear associations were observed with mortality from coronary heart disease. However, positive associations with sudden cardiac death were observed. The adjusted relative risk for men with definite isolated systolic hypertension was 9.20. The risk of dying from coronary heart disease not recorded additionally as sudden death was highest in men at the lower end of the DBP and SBP distributions and in men using antihypertensives. DBP and SBP were positively associated with all-cause mortality when possible comorbidity at the time of the blood pressure measurement was accounted for. Overall, the highest risk for all endpoints was observed in men on antihypertensive medication, who formed a distinct group with a clustering of cardiovascular risk factors. CONCLUSION: Elevated DBP and SBP, and especially isolated systolic hypertension, are important predictors of sudden cardiac death in elderly men. The highest risk of non-sudden coronary heart disease mortality was found at the lower end of the blood pressure distributions and among men on antihypertensive medication.