February 22, 2005Circulation
Predictors of New-Onset Diastolic and Systolic Hypertension
Key result
Compared with optimal blood pressure, normal and high-normal blood pressure significantly increased the 10-year risk of developing new-onset isolated diastolic hypertension (HR 2.75 and 3.29, P<0.0001).
Why the study?
What are the clinical predictors of new-onset isolated diastolic, systolic-diastolic, and isolated systolic hypertension in individuals free of cardiovascular disease?
Population
Participants in the Framingham Heart Study who had undergone 2 biennial examinations between 1953 and 1957…
Design
Cohort
Follow-up
10 years
Authors
Discussion
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Member takes
Implication
Different risk factor profiles predict hypertension subtypes; leaves open whether subtype-targeted prevention improves outcomes.
Key Points
- To examine how baseline blood pressure categories and clinical risk factors differentially predict the 10-year development of isolated diastolic, systolic-diastolic, and isolated systolic hypertension.
- Followed Framingham Heart Study participants who completed two biennial examinations between 1953 and 1957, excluding those receiving antihypertensive therapy or with baseline cardiovascular disease.
- Estimated multivariable-adjusted hazard ratios (HRs) for new-onset isolated diastolic (IDH), systolic-diastolic (SDH), and isolated systolic (ISH) hypertension over a 10-year follow-up compared with optimal blood pressure (<120/<80 mm Hg).
- Compared with optimal blood pressure, high-normal blood pressure significantly increased risk for new-onset IDH (HR 3.29, P<0.0001), SDH (HR 7.96, P<0.0001), and ISH (HR 4.82, P<0.0001).
- Existing IDH carried the highest risk for progression to SDH (HR 23.12, P<0.0001), while ISH developed more frequently from normal (HR 3.26, P<0.0001) and high-normal blood pressure than from IDH (HR 1.39, P=0.24).
- Baseline body mass index (BMI), weight gain during follow-up, younger age, and male sex predicted new-onset IDH, whereas new-onset ISH was predicted by older age, female sex, and weight gain during follow-up.
Study Design
Type
Cohort
Structured PICO
What are the clinical predictors of new-onset isolated diastolic, systolic-diastolic, and isolated systolic hypertension in individuals free of cardiovascular disease?
P
Population
Participants in the Framingham Heart Study, free of antihypertensive therapy and cardiovascular disease, followed for 10 years to assess predictors of new-onset hypertension.
O
Outcome
New-onset of isolated diastolic (IDH), systolic-diastolic (SDH), and isolated systolic (ISH) hypertension
Main Result
Hazard Ratio: 2.75
p-value: p=<0.0001
Increased baseline BMI and weight gain predict new-onset isolated diastolic hypertension, which has a high probability of transitioning to systolic-diastolic hypertension, suggesting it is not a benign condition.
Cite This Study
Franklin et al. (2005) conducted a cohort in Hypertension. Normal and high-normal blood pressure vs. Optimal blood pressure (SBP <120 and DBP <80 mm Hg) was evaluated on New-onset isolated diastolic hypertension (IDH) (HR 2.75, p=<0.0001). Compared with optimal blood pressure, normal and high-normal blood pressure significantly increased the 10-year risk of developing new-onset isolated diastolic hypertension (HR 2.75 and 3.29, P<0.0001).