Article Text

Download PDFPDF

Original article
Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study
  1. Javed Butler1,
  2. Andreas P Kalogeropoulos1,
  3. Vasiliki V Georgiopoulou1,
  4. Kirsten Bibbins-Domingo2,
  5. Samer S Najjar3,
  6. Kim C Sutton-Tyrrell4,
  7. Tamara B Harris5,
  8. Stephen B Kritchevsky6,
  9. Donald M Lloyd-Jones7,
  10. Anne B Newman8,
  11. Bruce M Psaty9
  1. 1Department of Medicine, Emory University, Atlanta, Georgia, USA
  2. 2Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  3. 3Washington Hospital Center, MedStar Health Research Institute, Washington, District of Columbia, USA
  4. 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
  5. 5Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
  6. 6Department of Medicine/Geriatrics and Gerontology Wake Forest University, Winston-Salem, North Carolina, USA
  7. 7Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
  8. 8Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
  9. 9Departments of Medicine and Epidemiology University of Washington, Seattle, Washington, USA
  1. Correspondence to Javed Butler, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road NE, Suite 504, Atlanta, GA 30322, USA; javed.butler{at}


Background The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs.

Objective To examine the association between SBP and HF risk in the elderly.

Design Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989–90 and 1992–3) and the Health ABC Study (inception: 1997–8).

Setting Community-based cohorts.

Participants 4408 participants (age, 72.8 (4.9) years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive drugs at baseline.

Main outcome measures Incident HF, defined as first adjudicated hospitalisation for HF.

Results Over 10 years, 493 (11.2%) participants developed HF. Prehypertension (120–139 mm Hg), stage 1 (140–159 mm Hg), and stage 2 (≥160 mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (<120 mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI 1.23 to 2.16; p=0.001), 2.21 (95% CI 1.65 to 2.96; p<0.001) and 2.60 (95% CI 1.85 to 3.64; p<0.001), respectively. Overall 255/493 (51.7%) HF events occurred in participants with SBP <140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race–SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women.

Conclusions There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mm Hg; over half of incident HF events occur in individuals with SBP <140 mm Hg.

  • Epidemiology
  • hypertension
  • heart failure
  • risk stratification
View Full Text

Statistics from


  • Funding This research was supported by contract numbers N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, grant U01 HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke (Cardiovascular Health Study), and contract numbers N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106 from the National Institute of Ageing (Health ABC Study). A full list of the Cardiovascular Health Study investigators and institutions can be found at This research was also supported in part by the Intramural Research Program of the NIH, National Institute on Ageing, by an Emory University Heart and Vascular Board grant entitled ‘Novel Risk Markers and Prognosis Determination in Heart Failure’, and by PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, NIH, National Center for Research Resources.

  • Competing interests There are no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval This study was conducted with the approval of the corresponding study sites of the Cardiovascular Health Study and Health ABC Study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.