Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.
BACKGROUND
The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown.


OBJECTIVE
To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk.


METHODS
Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998).


METHODS
Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications.


RESULTS
The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (greater-than-or-equal to 140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (greater-than-or-equal to 160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure.


CONCLUSIONS
The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.
Vasan
Ramachandran S
RS
Framingham Heart Study, 5 Thurber St, Framingham, MA 01702, USA. vasan@fram.nhlbi.nih.gov
Beiser
Alexa
A
Seshadri
Sudha
S
Larson
Martin G
MG
Kannel
William B
WB
D'Agostino
Ralph B
RB
Levy
Daniel
D
D000959:Antihypertensive Agents; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents