A1 Refereed original research article in a scientific journal
Trajectories of Blood Pressure Elevation Preceding Hypertension Onset An Analysis of the Framingham Heart Study Original Cohort
Authors: Teemu J. Niiranen, Mir Henglin, Brian Claggett, Vito M. R. Muggeo, Elizabeth McCabe, Mohit Jain, MD, Ramachandran S. Vasan, Martin G. Larson, Susan Cheng
Publisher: AMER MEDICAL ASSOC
Publication year: 2018
Journal: JAMA Cardiology
Journal name in source: JAMA CARDIOLOGY
Journal acronym: JAMA CARDIOL
Volume: 3
Issue: 5
First page : 427
Last page: 431
Number of pages: 5
ISSN: 2380-6583
DOI: https://doi.org/10.1001/jamacardio.2018.0250
Abstract
IMPORTANCE Given that hypertension remains a leading risk factor for chronic disease globally, there are substantial ongoing efforts to define the optimal range of blood pressure (BP).OBJECTIVE To identify a common threshold level above which BP rise tends to accelerate in progression toward hypertension.DESIGN. SETTING, AND PARTICIPANTS This longitudinal, community-based epidemiological cohort study of adults enrolled in Framingham, Massachusetts, included 1252 participants (mean [SD] age, 35.3 [2.7] years) from the Framingham Original Cohort, of whom 790 (63.1%) were women. Each participant contributed up to 28 serial examinations of standardized resting BP measurements between 1948 and 2005.EXPOSURES Age and systolic BRMAIN OUTCOMES AND MEASURES Via a segmented mixed model, we identified significant change points in the association between advancing age and increasing systolic BP among individuals categorized by their age of hypertension onset.RESULTS Individuals maintained a relatively stable resting systolic BP level prior to hypertension onset. Systolic BP level began to rise at a more rapid rate after reaching a level of 123.2 mm Hg (95% CI, 122.7-130.1 mm Hg) in people with onset at 40 to 49 years; 122.0 mm Hg (95% CI, 120.3-123.9 mm Hg) in those with onset between 50 and 59 years, 124.9 mm Hg (95% CI, 120.2-127.9 mm Hg) in those with onset between 60 and 69 years, and 120.5 mm Hg (95% CI, 118.0-123.2 mm Hg) in those with onset between 70 and 79 years (P = .29 for between-group heterogeneity).CONCLUSIONS AND RELEVANCE We observed that individuals in the community generally maintained a systolic BP of less than 120 to 125 mm Hg, above which systolic BP increased at a relatively rapid rate toward overt hypertension. This trend was consistent whether the hypertension manifested earlier or later in life. Thus, a resting systolic BP that chronically exceeds the range of approximately 120 to 125 mm Hg may represent an important threshold of underlying vascular remodeling and signal incipient hypertension irrespective of age. Further investigations are needed to unravel the sequence of hemodynamic and vascular changes occurring prior to hypertension onset.
IMPORTANCE Given that hypertension remains a leading risk factor for chronic disease globally, there are substantial ongoing efforts to define the optimal range of blood pressure (BP).OBJECTIVE To identify a common threshold level above which BP rise tends to accelerate in progression toward hypertension.DESIGN. SETTING, AND PARTICIPANTS This longitudinal, community-based epidemiological cohort study of adults enrolled in Framingham, Massachusetts, included 1252 participants (mean [SD] age, 35.3 [2.7] years) from the Framingham Original Cohort, of whom 790 (63.1%) were women. Each participant contributed up to 28 serial examinations of standardized resting BP measurements between 1948 and 2005.EXPOSURES Age and systolic BRMAIN OUTCOMES AND MEASURES Via a segmented mixed model, we identified significant change points in the association between advancing age and increasing systolic BP among individuals categorized by their age of hypertension onset.RESULTS Individuals maintained a relatively stable resting systolic BP level prior to hypertension onset. Systolic BP level began to rise at a more rapid rate after reaching a level of 123.2 mm Hg (95% CI, 122.7-130.1 mm Hg) in people with onset at 40 to 49 years; 122.0 mm Hg (95% CI, 120.3-123.9 mm Hg) in those with onset between 50 and 59 years, 124.9 mm Hg (95% CI, 120.2-127.9 mm Hg) in those with onset between 60 and 69 years, and 120.5 mm Hg (95% CI, 118.0-123.2 mm Hg) in those with onset between 70 and 79 years (P = .29 for between-group heterogeneity).CONCLUSIONS AND RELEVANCE We observed that individuals in the community generally maintained a systolic BP of less than 120 to 125 mm Hg, above which systolic BP increased at a relatively rapid rate toward overt hypertension. This trend was consistent whether the hypertension manifested earlier or later in life. Thus, a resting systolic BP that chronically exceeds the range of approximately 120 to 125 mm Hg may represent an important threshold of underlying vascular remodeling and signal incipient hypertension irrespective of age. Further investigations are needed to unravel the sequence of hemodynamic and vascular changes occurring prior to hypertension onset.
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