Background Isolated systolic hypertension (ISH) is common in older adults and is a risk factor for incident heart failure (HF). We examined the association of systolic–diastolic hypertension (SDH) with incident HF and other outcomes in older adults. Methods In the Cardiovascular Health Study (CHS), 5776 community-dwelling adults ≥ 65 years had data on baseline systolic and diastolic blood pressure (SBP and DBP). We excluded those with DBP < 60 mmHg (n = 821), DBP ≥ 90 and SBP < 140 mmHg (n = 28), normal BP, taking anti-hypertensive drugs (n = 1138), normal BP, not taking anti-hypertensive drugs, history of hypertension (n = 193), and baseline HF (n = 101). Of the remaining 3495, 1838 had ISH (SBP ≥ 140 and DBP < 90 mmHg) and 240 had SDH (SBP ≥ 140 and DBP ≥ 90 mmHg). The main outcome was centrally-adjudicated incident HF over 13 years of follow-up. Results Participants had a mean (± SD) age of 73 (± 6) years, 57% were women, and 16% African American. Incident HF occurred in 25%, 22% and 11% of participants with ISH, SDH and no hypertension, respectively. Compared to no hypertension, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident HF associated with ISH and SDH were 1.86 (1.51–2.30) and 1.73 (1.23–2.42), respectively. Cardiovascular mortality occurred in 22%, 24% and 9% of those with ISH, SDH and no hypertension, respectively with respective multivariable-adjusted HRs (95% CIs) of 1.88 (1.49–2.37) and 2.30 (1.64–3.24). Conclusion Among older adults with hypertension, both SDH and ISH have similar associations with incident HF and cardiovascular mortality.
