New-onset hypertension was associated with a higher 12-year cumulative incidence of a first cardiovascular event compared to noncardiovascular death in both men (HR 2.53) and women (HR 1.58).
Cohort (n=1,347)
No
Does new-onset hypertension increase the risk of experiencing a cardiovascular event first rather than noncardiovascular death in patients free of baseline cardiovascular disease?
After hypertension onset, patients are significantly more likely to experience a cardiovascular event before noncardiovascular death, with the specific type of initial event varying by gender, age, and hypertension severity.
Effect estimate: HR 2.53 (95% CI 1.83 to 3.50)
Absolute Event Rate: 24.7% vs 9.8%
Hypertension confers risk for multiple types of cardiovascular events, but competing risks for these outcomes are unknown. We estimated the competing risks over 12 years after hypertension onset among cases and age-, sex-, and examination-matched controls using competing Cox cumulative incidence and proportional hazards models. We included all Framingham Heart Study subjects examined after 1977 with new-onset hypertension who were free of cardiovascular disease. There were 645 men and 702 women with new-onset hypertension (mean age: men, 55+/-12 years; women, 59+/-12 years). Compared with matched nonhypertensive controls, subjects with new-onset hypertension were more likely to experience a cardiovascular event first rather than noncardiovascular death. Among new-onset hypertensives, the 12-year competing cumulative incidence of any cardiovascular end point as a first event in men was 24.7%, compared with 9.8% for noncardiovascular death (hazards ratio HR, 2.53; 95% confidence interval CI, 1.83 to 3.50); in women, the competing incidences were 16.0% versus 10.1%, respectively (HR, 1.58; 95% CI, 1.13 to 2.20). The most common first major cardiovascular events were hard coronary disease (8.2%) in men and stroke (5.2%) in women. Type and incidence of first cardiovascular events varied by age and severity of hypertension at onset, with stroke predominating among older subjects with new-onset hypertension. After hypertension onset, cardiovascular events are more likely to occur first as opposed to noncardiovascular death. Types of initial events differ by gender, age, and severity of hypertension at onset. These results represent a novel approach to understanding the complications of hypertension and may help target therapies for patients with new-onset hypertension to optimize prevention strategies.
Lloyd‐Jones et al. (2004) conducted a cohort in New-onset hypertension (n=1,347). New-onset hypertension vs. Matched nonhypertensive controls was evaluated on Any cardiovascular end point as a first event versus noncardiovascular death in men (HR 2.53, 95% CI 1.83 to 3.50). New-onset hypertension was associated with a higher 12-year cumulative incidence of a first cardiovascular event compared to noncardiovascular death in both men (HR 2.53) and women (HR 1.58).