title: Family history of premature cardiovascular disease: blood pressure control and long-term mortality outcomes in hypertensive patients.
abstract: OBJECTIVE
  Current guidelines recommend early referral and initiation of intensive cardiovascular (CV) risk reduction in individuals with a positive family history of coronary heart disease (CHD). We hypothesized that a family history of premature CHD and stroke [CV disease (CVD)] would lead to earlier referral of hypertensive patients to secondary care clinic, leading to better control of risk factors, mitigating the excess risk seen in these individuals.
  
  
  RESULTS
  We studied the association of a positive family history of CVD in 10 787 individuals with longitudinal changes in risk factors and long-term cause-specific mortality in the Glasgow Blood Pressure Clinic using generalized estimating equations and the Cox proportional hazard models, respectively. The total time at risk was 193 756 person-years with a median survival time of 29.2 years. A positive family history of CVD was associated with an earlier presentation to the clinic, a lower burden of traditional CV risk factors, and similar longitudinal blood pressure reduction and drug adherence compared with those without. But despite these positive features, all-cause [hazard ratio (HR) = 1.12, 95% confidence interval 1.01-1.25] and CV (HR = 1.20, 1.04-1.38) mortality independent of baseline risk factors were worse. Consistent results were observed in propensity score-matched analysis. Inclusion of family history of CVD did not improve mortality risk discrimination over and above traditional risk factors.
  
  
  CONCLUSIONS
  Our study suggests that despite earlier referral and treatment of individuals with a positive family history of premature CVD, excess risk persists, indicating the need for continued and sustained efforts to reduce risk factors and drug adherence in these individuals.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Williamson
authors.forename: Panniyammakal
authors.initials: P
authors.lastname: Jeemon
authors.forename: Claire E
authors.initials: CE
authors.lastname: Hastie
authors.forename: Linsay
authors.initials: L
authors.lastname: McCallum
authors.forename: Scott
authors.initials: S
authors.lastname: Muir
authors.forename: Jesse
authors.initials: J
authors.lastname: Dawson
authors.forename: Matthew
authors.initials: M
authors.lastname: Walters
authors.forename: William
authors.initials: W
authors.lastname: Sloan
authors.forename: David
authors.initials: D
authors.lastname: Morrison
authors.forename: Anna F
authors.initials: AF
authors.lastname: Dominiczak
authors.forename: Jill
authors.initials: J
authors.lastname: Pell
authors.forename: Sandosh
authors.initials: S
authors.lastname: Padmanabhan
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000235:genetics* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010375:Pedigree; D011379:Prognosis; D057216:Propensity Score; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: Epidemiology; Family history; Hypertension; Mortality