ORIGINAL ARTICLE Impaired glucose metabolism and obesity in Swedish patients with borderline isolated systolic hypertension: Skaraborg Hypertension and Diabetes Project E. Bùg-Hansen, 1,2 U. Lindblad, 1,3 J. Ranstam, 4 A. Melander 1,4 and L. Ra Ê stam 1,5 1 Department of Community Medicine, Malmo È University Hospital, Malmo È, Sweden 2 Skara Health Care Centre, Skara, Sweden 3 Skaraborg Institute, Sko È vde, Sweden 4 The NEPI Foundation, Malmo È and Stockholm, Sweden 5 National Public Health Institute, Stockholm, Sweden Aim: To assess the prevalence of borderline isolated systolic hypertension (borderline ISH), and to examine its association with other cardiovascular risk factors. Methods: A cross-sectional community-based study was carried out in 1993±1994 in Skara, Sweden, including 1109 randomly chosen subjects > 40 years old. Normotension (NT) was de®ned as systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg, borderline ISH as SBP 140±159 and DBP < 90 mmHg and hypertension (HT) as SBP >160 or DBP > 90 mmHg or ongoing treatment. Results: The prevalence of borderline ISH (n = 203) by age was 4% in ages 40±49 years, 15% in ages 50±59 years, 28% in ages 60±69 years and 25% in ages 70±79 years. With borderline ISH as reference, normotensive subjects less often had fasting blood glucose > 5.5 mmol/l (odds ratio (OR): 0.4, 95% CI: 0.26±0.75), BMI > 27 kg/m 2 (OR: 0.6, 95% con®dence intervals (CI): 0.42±0.85) and known diabetes (OR: 0.4, 95% CI: 0.16±0.95). Hypertensive subjects more often had high density lipoprotein (HDL) cholesterol < 1.0 mmol/l (OR: 2.0, 95% CI: 1.35±2.99), a history of previous cardiovascular disease (CVD) (OR: 1.7, 95% CI: 1.01±2.72), known diabetes (OR: 2.4, 95% CI: 1.29±4.58) and microalbuminuria (men) (OR: 1.9, 95% CI: 1.15±3.11). Conclusion: Borderline ISH is a common condition. It is associated with a more unfavourable risk factor pro®le than that of normotensive subjects concerning primarily glucose metabolism and obesity. The prevalence of known diabetes increased with the degree of hypertension. Keywords: primary health care, borderline isolated systolic hypertension, diabetes, obesity. Received 5 January 2000; returned for revision 1 February 2000; revised version accepted 22 February 2000 Introduction High systolic (SBP) and diastolic blood pressure (DBP) are associated with increased risk of cardiovas- cular morbidity and mortality. Borderline isolated systolic hypertension (borderline ISH), de®ned as systolic blood pressure between 140 and 159 mmHg and diastolic blood pressure below 90 mmHg, has been associated with increased risk of progression to de®nite hypertension (HT) as well as with increased risks of cardio-vascular diseases [1±2]. In observa- tional studies no threshold has been found above which the risk associated with systolic blood pressure increases promptly, but the risk has increased con- tinuously from low to high levels [3,4]. In recent years diagnostic criteria for hypertension successively have lowered the level of systolic blood pressure. Current international guidelines even recommend Correspondence: Dr Erik Bùg-Hansen, MD, Skara Health Care Centre Malmgatan 36, S-53232 Skara, Sweden. E-mail: fou-enheten.skara@swipnet.se | OA ã 2001 Blackwell Science Ltd Diabetes, Obesity and Metabolism, 3, 2001, 25±31 | 25