Isolated systolic hypertension and mortality after age 60 years. A prospective population-based study.

A total of 165 out of 2636 adults aged 60 years or older (6.3 per cent) in Rancho Bernardo, California, had isolated systolic hypertension with a systolic blood pressure greater than or equal to 160 mmHg and a diastolic blood pressure less than 90 mmHg when studied in 1972-1974. A 6.4-year follow-up of this cohort showed isolated systolic hypertension to be as important a risk factor for all-cause mortality as other types of hypertension in both men and women (adjusted relative risk = 1.5, p greater than 0.10). After adjustment for age and other covariates, male but not female subjects with isolated systolic hypertension experienced an excess risk of death from stroke (relative risk = 4.0, p less than 0.10), a relative risk exceeding that seen in men with treated hypertension. Isolated systolic hypertension was unassociated with an excess risk of fatal ischemic heart disease in subjects of either sex in this population. The excess risk of death and stroke is consistent with results published elsewhere, and supports the concept that isolated systolic hypertension is not a benign condition of the elderly. The efficacy and safety of therapeutic intervention in older adults with isolated systolic hypertension remain to be determined.