What is the clinical evidence from this study?

Study design: Cohort. Population: Normotension (risk of incident hypertension) (n=187). Intervention: Baseline serum lipoproteins (HDL3-C). Primary outcome: Hypertension development (initiation of antihypertensive therapy or SBP >160 mmHg or DBP >90 mmHg) (RR 0.8 per 5 mg/dL, 95% CI 0.42-1.0).

May 24, 2004

Lipoprotein Levels Are Associated with Incident Hypertension in Older Adults

Q: What does this research mean for the field?

Lower baseline HDL3-C and higher baseline systolic blood pressure are significant independent predictors of incident hypertension in older adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Lower baseline HDL3-C (RR 0.8 per 5 mg/dL; 95% CI 0.42-1.0) and higher baseline SBP were significant independent predictors of incident hypertension in older adults over 8 years.

Study Design

Type

Cohort (n=187)

Multicenter

Structured PICO

Are baseline serum lipoprotein levels associated with incident hypertension in older normotensive adults?

Population

187 older adult men and women (mean age 71.3), normotensive (systolic blood pressure <160 mmHg, diastolic blood pressure <90 mmHg) at baseline, from the Pittsburgh site of the Systolic Hypertension in the Elderly Program (SHEP).

Intervention

Baseline serum lipoprotein levels (total cholesterol, LDL-C, HDL-C, HDL(2)-C, HDL(3)-C, triglycerides, and apolipoproteins 1, 2, and B)

Outcome

Hypertension development, defined as initiation of antihypertensive therapy or SBP >160 mmHg or DBP >90 mmHg over 8 yearshard clinical

Abnormal serum lipoproteins, specifically lower HDL(3)-C, are associated with an increased risk of developing hypertension in older adults.

Main Result

Effect estimate: RR 0.8 per 5 mg/dL (95% CI 0.42-1.0)

Abstract

OBJECTIVES: To determine the relationship between baseline measures of serum lipoproteins and incident hypertension in older adults. DESIGN: Prospective cohort study. SETTING: Pittsburgh, Pennsylvania, site of Systolic Hypertension in the Elderly Program (SHEP). PARTICIPANTS: One hundred eighty-seven men and women (mean age 71.3), normotensive (systolic blood pressure (SBP) <160 mmHg, diastolic blood pressure (DBP) <90 mmHg) at baseline, were followed annually over 8 years as an ancillary study to the SHEP. MEASUREMENTS: Hypertension development, defined as initiation of antihypertensive therapy or SBP greater than 160 mmHg or DBP greater than 90 mmHg. Lipoprotein measures included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), HDL(2)-C, HDL(3)-C, triglycerides, and apolipoproteins 1, 2, and B. RESULTS: Over 8 years, 44 participants developed hypertension, for a Kaplan-Meier cumulative incidence rate of 31% (95% confidence interval (CI)=23-39%). Cumulative incidence rates were highly associated with baseline SBP, ranging from 8% in those with baseline SBP less than 120 mmHg to 70% in those with SBP of 140 to 159 mmHg. Other univariate associations included higher DBP, pulse pressure (P <.01 for both), triglycerides (P=.03), apolipoprotein B (P=.03), and lower HDL-C (P=.04) and HDL(3)-C (P=.02). In multivariate Cox regression analysis, higher baseline SBP (relative risk (RR)=1.8 per 10 mmHg, 95% CI=1.5-2.3) and lower HDL(3)-C (RR=0.8 per 5 mg/dL, 95% CI=0.42-1.0) remained significant independent predictors of time to hypertension. CONCLUSION: Older adults with abnormal serum lipoproteins are at increased risk of developing hypertension. Clinical trials exploring the effects of the modification of lipoprotein levels on hypertension incidence rates are needed.

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