Predictors of new-onset diastolic and systolic hypertension: the Framingham Heart Study.
BACKGROUND
Factors leading differentially to the development of isolated diastolic (IDH), systolic-diastolic (SDH), and isolated systolic (ISH) hypertension are poorly understood. We examined the relations of blood pressure (BP) and clinical risk factors to the new onset of the 3 forms of hypertension.


RESULTS
Participants in the Framingham Heart Study were included if they had undergone 2 biennial examinations between 1953 and 1957 and were free of antihypertensive therapy and cardiovascular disease. Compared with optimal BP (SBP <120 and DBP <80 mm Hg), the adjusted hazard ratios (HRs) for developing new-onset IDH over the ensuing 10 years were 2.75 for normal BP, 3.29 for high-normal BP (both P<0.0001), 1.31 (P=0.40) for SDH, and 0.61 (P=0.36) for ISH. The HRs of developing new-onset SDH were 3.32, 7.96, 7.10, and 23.12 for the normal BP, high-normal BP, ISH, and IDH groups, respectively (all P<0.0001). The HRs of developing ISH were 3.26 for normal and 4.82 for high-normal BP (both P<0.0001), 1.39 (P=0.24) for IDH, and 1.69 (P<0.01) for SDH. Increased body mass index (BMI) during follow-up predicted new-onset IDH and SDH. Other predictors of IDH were younger age, male sex, and BMI at baseline. Predictors of ISH included older age, female sex, and increased BMI during follow-up.


CONCLUSIONS
Given the propensity for increased baseline BMI and weight gain to predict new-onset IDH and the high probability of IDH to transition to SDH, it is likely that IDH is not a benign condition. ISH arises more commonly from normal and high-normal BP than from "burned-out" diastolic hypertension.
Franklin
Stanley S
SS
Heart Disease Prevention Program, University of California, C240 Medical Sciences, Irvine, CA 92697, USA. ssfranklinmd@earthlink.net
Pio
Jose R
JR
Wong
Nathan D
ND
Larson
Martin G
MG
Leip
Eric P
EP
Vasan
Ramachandran S
RS
Levy
Daniel
D
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013599:Systole; D014655:Vascular Resistance; D015430:Weight Gain
D000959:Antihypertensive Agents