title: Residual Cardiovascular Risk in Individuals on Blood Pressure-Lowering Treatment.
abstract: BACKGROUND
  Hypertensive individuals on blood pressure (BP)-lowering treatment with BP in the normal or high-normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals.
  
  
  RESULTS
  We assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP-lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow-up of 11 years; group 1, 0.65 event per 100 person-years; group 5, 3.20 events per 100 person-years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI -6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden.
  
  
  CONCLUSIONS
  Treated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.
authors.affiliation: Framingham Heart Study, Framingham, MA (W.L., D.M.E., R.S.V.) Institute of Epidemiology, Christian Albrechts University Kiel, Kiel, Germany (W.L.).
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lieb
authors.affiliation: Framingham Heart Study, Framingham, MA (W.L., D.M.E., R.S.V.) Sections of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA (D.M.E., R.S.V.).
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Enserro
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA (L.M.S.).
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Sullivan
authors.affiliation: Framingham Heart Study, Framingham, MA (W.L., D.M.E., R.S.V.) Sections of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA (D.M.E., R.S.V.) Department of Epidemiology, Boston University School of Public Health, Boston, MA (R.S.V.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D001794:Blood Pressure / Q000187:drug effects*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cardiovascular disease; subclinical disease