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Brief Report
March 21, 2018

Trajectories of Blood Pressure Elevation Preceding Hypertension OnsetAn Analysis of the Framingham Heart Study Original Cohort

Author Affiliations
  • 1Framingham Heart Study, Boston University, Framingham, Massachusetts
  • 2Division of Medicine, Turku University Hospital, Turku, Finland
  • 3Department of Medicine, University of Turku, Turku, Finland
  • 4Department of Public Health Solutions, National Institute for Health and Welfare, Turku, Finland
  • 5Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
  • 6Harvard Medical School, Boston, Massachusetts
  • 7Dipartimento di Scienze Economiche, Aziendali e Statistiche, Universita’ di Palermo, Italy
  • 8Department of Medicine, University of California–San Diego, La Jolla
  • 10Division of Cardiology, Department of Medicine, Boston University, Boston, Massachusetts
  • 11Division of Preventive Medicine, Department of Medicine, Boston University, Boston, Massachusetts
  • 12Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
JAMA Cardiol. Published online March 21, 2018. doi:10.1001/jamacardio.2018.0250
Key Points

Question  Is there a common threshold level above which blood pressure rise tends to accelerate in progression toward hypertension?

Findings  This community-based longitudinal cohort study found that, prior to hypertension onset, individuals generally maintained a resting systolic blood pressure of less than 120 to 125 mm Hg. Above this level, resting systolic blood pressure increased at a more rapid rate over time, a consistent trend whether hypertension manifested earlier or later in life.

Meaning  A resting systolic blood pressure that chronically exceeds approximately 120 to 125 mm Hg tends to signal incipient hypertension, irrespective of age.

Abstract

Importance  Given that hypertension remains a leading risk factor for chronic disease globally, there are substantial ongoing efforts to define the optimal range of blood pressure (BP).

Objective  To identify a common threshold level above which BP rise tends to accelerate in progression toward hypertension.

Design, Setting, and Participants  This longitudinal, community-based epidemiological cohort study of adults enrolled in Framingham, Massachusetts, included 1252 participants (mean [SD] age, 35.3 [2.7] years) from the Framingham Original Cohort, of whom 790 (63.1%) were women. Each participant contributed up to 28 serial examinations of standardized resting BP measurements between 1948 and 2005.

Exposures  Age and systolic BP.

Main Outcomes and Measures  Via a segmented mixed model, we identified significant change points in the association between advancing age and increasing systolic BP among individuals categorized by their age at hypertension onset.

Results  Individuals maintained a relatively stable resting systolic BP level prior to hypertension onset. Systolic BP level began to rise at a more rapid rate after reaching a level of 123.2 mm Hg (95% CI, 122.7-130.1 mm Hg) in people with onset at 40 to 49 years; 122.0 mm Hg (95% CI, 120.3-123.9 mm Hg) in those with onset between 50 and 59 years, 124.9 mm Hg (95% CI, 120.2-127.9 mm Hg) in those with onset between 60 and 69 years, and 120.5 mm Hg (95% CI, 118.0-123.2 mm Hg) in those with onset between 70 and 79 years (P = .29 for between-group heterogeneity).

Conclusions and Relevance  We observed that individuals in the community generally maintained a systolic BP of less than 120 to 125 mm Hg, above which systolic BP increased at a relatively rapid rate toward overt hypertension. This trend was consistent whether the hypertension manifested earlier or later in life. Thus, a resting systolic BP that chronically exceeds the range of approximately 120 to 125 mm Hg may represent an important threshold of underlying vascular remodeling and signal incipient hypertension irrespective of age. Further investigations are needed to unravel the sequence of hemodynamic and vascular changes occurring prior to hypertension onset.

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