Aging, blood pressure, and heart failure: what are the connections?

Although systolic blood pressure (BP; SBP) is the best predictor of future cardiovascular disease (CVD) risk for the majority of the older hypertensive population, there is much that can be learned from simultaneously assessing diastolic BP (DBP) and its relation to levels of SBP.1 After 50 years of age, SBP increases disproportionately to DBP, and after 60 years of age DBP falls, resulting in a widening of the pulse pressure (PP).1 Indeed, a previous Framingham Heart Study report revealed an age-related gradual shift from DBP below 50 years of age to SBP and PP at older ages as predictors of coronary heart disease risk.2 Furthermore, with the age-related rise in SBP and fall in DBP, isolated SBP (ISH), accompanied by a wide PP, becomes the most common form of hypertension from middle-aged onward3 and is associated with increased CVD risk in general4 and overt heart failure in particular.5