Key result
Hypertension by age 55 is linked to an up to ~70% lifetime CVD risk.
Why the study?
Prior estimates of lifetime risk for cardiovascular disease examined blood pressure at the index age but did not account for changes in blood pressure over time.
Does maintaining or decreasing blood pressure to normal levels during middle age reduce the remaining lifetime risk for cardiovascular disease?
Cohort (n=61,585)
Yes
Does maintaining or decreasing blood pressure to normal levels during middle age reduce the remaining lifetime risk for cardiovascular disease?
Maintaining or decreasing blood pressure to normal levels during middle age significantly reduces the remaining lifetime risk for cardiovascular disease.
Maintaining normal BP by middle age was associated with lowest lifetime CVD risk; extends risk estimates but leaves open causal effects of intervention.
BACKGROUND: Prior estimates of lifetime risk (LTR) for cardiovascular disease (CVD) examined the impact of blood pressure (BP) at the index age and did not account for changes in BP over time. We examined how changes in BP during middle age affect LTR for CVD, coronary heart disease, and stroke. METHODS AND RESULTS: Data from 7 diverse US cohort studies were pooled. Remaining LTRs for CVD, coronary heart disease, and stroke were estimated for white and black men and women with death free of CVD as a competing event. LTRs for CVD by BP strata and by changes in BP over an average of 14 years were estimated. Starting at 55 years of age, we followed up 61 585 men and women for 700 000 person-years. LTR for CVD was 52.5% (95% confidence interval, 51.3-53.7) for men and 39.9% (95% confidence interval, 38.7-41.0) for women. LTR for CVD was higher for blacks and increased with increasing BP at index age. Individuals who maintained or decreased their BP to normal levels had the lowest remaining LTR for CVD, 22% to 41%, compared with individuals who had or developed hypertension by 55 years of age, 42% to 69%, suggesting a dose-response effect for the length of time at high BP levels. CONCLUSIONS: Individuals who experience increases or decreases in BP in middle age have associated higher and lower remaining LTR for CVD. Prevention efforts should continue to emphasize the importance of lowering BP and avoiding or delaying the incidence of hypertension to reduce the LTR for CVD.
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Allen et al. (2011) conducted a cohort in Cardiovascular disease (n=61,585). Hypertension or developing hypertension by age 55 vs. Maintaining or decreasing blood pressure to normal levels was evaluated on Remaining lifetime risk for cardiovascular disease. Developing or maintaining hypertension by age 55 was associated with a higher remaining lifetime risk for CVD (42%-69%) compared to maintaining or decreasing BP to normal levels (22%-41%).
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