title: Impact of blood pressure and blood pressure change during middle age on the remaining lifetime risk for cardiovascular disease: the cardiovascular lifetime risk pooling project.
abstract: BACKGROUND
  Prior estimates of lifetime risk (LTR) for cardiovascular disease (CVD) examined the impact of blood pressure (BP) at the index age and did not account for changes in BP over time. We examined how changes in BP during middle age affect LTR for CVD, coronary heart disease, and stroke.
  
  
  RESULTS
  Data from 7 diverse US cohort studies were pooled. Remaining LTRs for CVD, coronary heart disease, and stroke were estimated for white and black men and women with death free of CVD as a competing event. LTRs for CVD by BP strata and by changes in BP over an average of 14 years were estimated. Starting at 55 years of age, we followed up 61 585 men and women for 700 000 person-years. LTR for CVD was 52.5% (95% confidence interval, 51.3-53.7) for men and 39.9% (95% confidence interval, 38.7-41.0) for women. LTR for CVD was higher for blacks and increased with increasing BP at index age. Individuals who maintained or decreased their BP to normal levels had the lowest remaining LTR for CVD, 22% to 41%, compared with individuals who had or developed hypertension by 55 years of age, 42% to 69%, suggesting a dose-response effect for the length of time at high BP levels.
  
  
  CONCLUSIONS
  Individuals who experience increases or decreases in BP in middle age have associated higher and lower remaining LTR for CVD. Prevention efforts should continue to emphasize the importance of lowering BP and avoiding or delaying the incidence of hypertension to reduce the LTR for CVD.
authors.affiliation: Department of Preventive Medicine and Division of Cardiology, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Ste 1102, Chicago, IL 60611, USA.
authors.forename: Norrina
authors.initials: N
authors.lastname: Allen
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Alan
authors.initials: A
authors.lastname: Dyer
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D015993:Life Tables; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors