Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study
Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 5...
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024202 |
| _version_ | 1797859017368797184 |
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| author | Maximillian T. Bourdillon Rebecca J. Song Ibrahim Musa Yola Vanessa Xanthakis Ramachandran S. Vasan |
| author_facet | Maximillian T. Bourdillon Rebecca J. Song Ibrahim Musa Yola Vanessa Xanthakis Ramachandran S. Vasan |
| author_sort | Maximillian T. Bourdillon |
| collection | DOAJ |
| description | Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 54% women). The prevalence of hypertension subtypes was as follows: nonhypertensive (systolic blood pressure [SBP] <140 mm Hg and diastolic blood pressure [DBP] <90 mm Hg), 79%; isolated systolic hypertension (ISH; SBP ≥140 mm Hg and DBP <90 mm Hg), 8%; isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg), 4%; and systolic‐diastolic hypertension (SDH; SBP ≥140 mm Hg and DBP ≥90 mm Hg), 9%. The prevalence of ISH and SDH increased with age. Analysis of a subsample of nonhypertensive participants demonstrated that increasing age, female sex, higher heart rate, left ventricular mass, and greater left ventricular concentricity were predictors of incident ISH and SDH. Higher baseline DBP was associated with the risk of developing isolated diastolic hypertension and SDH, whereas higher SBP was associated with all 3 hypertension subtypes. On follow‐up (median, 5.5 years), isolated diastolic hypertension often reverted to nonhypertensive BP (in 42% of participants) and ISH progressed to SDH (in 26% of participants), whereas SDH frequently transitioned to ISH (in 20% of participants). During follow‐up (median, 14.6 years), 889 participants developed cardiovascular disease. Compared with the nonhypertensive group (referent), ISH (adjusted hazard ratio [HR], 1.57; 95% CI, 1.30–1.90) and SDH (HR, 1.66; 95% CI, 1.36–2.01) were associated with increased cardiovascular disease risk, whereas isolated diastolic hypertension was not (HR, 1.03; 95% CI, 0.68–1.57). Conclusions Hypertension subtypes vary in prevalence with age, are dynamic during short‐term follow‐up, and exhibit distinctive prognoses, underscoring the importance of blood pressure subphenotyping. |
| first_indexed | 2024-04-09T21:22:41Z |
| format | Article |
| id | doaj.art-651c32a08ffc4d74b2a2a61ec833ea81 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:22:41Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-651c32a08ffc4d74b2a2a61ec833ea812023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.024202Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart StudyMaximillian T. Bourdillon0Rebecca J. Song1Ibrahim Musa Yola2Vanessa Xanthakis3Ramachandran S. Vasan4Internal Medicine Residency Program Boston University School of Medicine Boston MADepartment of Epidemiology Boston University School of Public Health Boston MASection of Preventive Medicine and Epidemiology Department of Medicine Boston University School of Medicine Boston MASection of Preventive Medicine and Epidemiology Department of Medicine Boston University School of Medicine Boston MADepartment of Epidemiology Boston University School of Public Health Boston MABackground The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 54% women). The prevalence of hypertension subtypes was as follows: nonhypertensive (systolic blood pressure [SBP] <140 mm Hg and diastolic blood pressure [DBP] <90 mm Hg), 79%; isolated systolic hypertension (ISH; SBP ≥140 mm Hg and DBP <90 mm Hg), 8%; isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg), 4%; and systolic‐diastolic hypertension (SDH; SBP ≥140 mm Hg and DBP ≥90 mm Hg), 9%. The prevalence of ISH and SDH increased with age. Analysis of a subsample of nonhypertensive participants demonstrated that increasing age, female sex, higher heart rate, left ventricular mass, and greater left ventricular concentricity were predictors of incident ISH and SDH. Higher baseline DBP was associated with the risk of developing isolated diastolic hypertension and SDH, whereas higher SBP was associated with all 3 hypertension subtypes. On follow‐up (median, 5.5 years), isolated diastolic hypertension often reverted to nonhypertensive BP (in 42% of participants) and ISH progressed to SDH (in 26% of participants), whereas SDH frequently transitioned to ISH (in 20% of participants). During follow‐up (median, 14.6 years), 889 participants developed cardiovascular disease. Compared with the nonhypertensive group (referent), ISH (adjusted hazard ratio [HR], 1.57; 95% CI, 1.30–1.90) and SDH (HR, 1.66; 95% CI, 1.36–2.01) were associated with increased cardiovascular disease risk, whereas isolated diastolic hypertension was not (HR, 1.03; 95% CI, 0.68–1.57). Conclusions Hypertension subtypes vary in prevalence with age, are dynamic during short‐term follow‐up, and exhibit distinctive prognoses, underscoring the importance of blood pressure subphenotyping.https://www.ahajournals.org/doi/10.1161/JAHA.121.024202blood pressurecardiovascular diseasecohort studiesepidemiologyhypertensionprognosis |
| spellingShingle | Maximillian T. Bourdillon Rebecca J. Song Ibrahim Musa Yola Vanessa Xanthakis Ramachandran S. Vasan Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease blood pressure cardiovascular disease cohort studies epidemiology hypertension prognosis |
| title | Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study |
| title_full | Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study |
| title_fullStr | Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study |
| title_full_unstemmed | Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study |
| title_short | Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study |
| title_sort | prevalence predictors progression and prognosis of hypertension subtypes in the framingham heart study |
| topic | blood pressure cardiovascular disease cohort studies epidemiology hypertension prognosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024202 |
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