This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vasan, R. S. Articles by D’Agostino, R. B. Search for Related Content PubMed PubMed Citation Articles by Vasan, R. S. Articles by D’Agostino, R. B. Related Collections Clinical Studies Chronic ischemic heart disease Epidemiology Primary prevention Brain Circulation and Metabolism

(Circulation. 2002;105:48.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Antecedent Blood Pressure and Risk of Cardiovascular Disease

The Framingham Heart Study

Ramachandran S. Vasan, MD; Joseph M. Massaro, PhD; Peter W.F. Wilson, MD; Sudha Seshadri, MD; Philip A. Wolf, MD; Daniel Levy, MD; Ralph B. D’Agostino, PhD

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (R.S.V., P.W.F.W., S.S., D.L.), Framingham, Mass; the Cardiology Section (R.S.V.), Preventive Medicine and Epidemiology (R.S.V., P.A.W., D.L.), Endocrinology Section (P.W.F.W.), and Department of Neurology (S.S., P.A.W.), Boston University School of Medicine, the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Deaconess Medical Center (D.L.), Harvard Medical School, and the Departments of Epidemiology and Biostatistics (J.M.M.) and Mathematics and Statistics (R.B.D.), Boston University, Boston, Mass; and the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 5 Thurber St, Framingham, MA 01702. E-mail vasan{at}fram.nhlbi.nih.gov

Background— Casual blood pressure (BP) is a powerful predictor of risk of cardiovascular disease (CVD), but a single BP determination may not accurately reflect the residual impact of antecedent BP levels on vascular risk. It is unclear whether time-averaged past BP measures incrementally improve CVD risk assessment.

Methods and Results— We used sex- and age-specific multivariable Cox regression to evaluate the association of current BP (at baseline), recent antecedent BP (average of readings for all available examinations 1 to 10 years before baseline), and remote antecedent BP (average for all available examinations 11 to 20 years before baseline) with the 10-year risk of CVD in 2313 Framingham Study subjects (910 men, 1403 women) free of CVD at baseline. During follow-up, 899 incident initial CVD events were observed (479 in women). In multivariable models incorporating established CVD risk factors, recent and remote antecedent BP predicted CVD risk incrementally over current BP. This effect was consistent in multiple subgroups: men and women, older and younger age groups, and lower and higher BP groups. The relations of antecedent BP to CVD risk were consistent for systolic BP, diastolic BP, and pulse pressure.

Conclusions— Antecedent BP is an important determinant of future risk of CVD events above and beyond current BP. When available, use of long-term average BP may improve the prognostic utility of conventional CVD risk prediction that is based on current BP. Our findings suggest that effective prevention of CVD requires adequate control of BP throughout life.

Key Words: blood pressure • cardiovascular diseases • epidemiology • risk factors

This article has been cited by other articles:

				M. J. Pletcher, K. Bibbins-Domingo, C. E. Lewis, G. S. Wei, S. Sidney, J. J. Carr, E. Vittinghoff, C. E. McCulloch, and S. B. Hulley Prehypertension during Young Adulthood and Coronary Calcium Later in Life Ann Intern Med, July 15, 2008; 149(2): 91 - 99. [Abstract] [Full Text] [PDF]

				E. Ingelsson, P. Gona, M. G. Larson, D. M. Lloyd-Jones, W. B. Kannel, R. S. Vasan, and D. Levy Altered Blood Pressure Progression in the Community and Its Relation to Clinical Events Arch Intern Med, July 14, 2008; 168(13): 1450 - 1457. [Abstract] [Full Text] [PDF]

				M. H. Sanders, J. M. Montserrat, R. Farre, and R. J. Givelber Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application Proceedings of the ATS, February 15, 2008; 5(2): 161 - 172. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				D. S. Lee, J. M. Massaro, T. J. Wang, W. B. Kannel, E. J. Benjamin, S. Kenchaiah, D. Levy, R. B. D'Agostino Sr, and R. S. Vasan Antecedent Blood Pressure, Body Mass Index, and the Risk of Incident Heart Failure in Later Life Hypertension, November 1, 2007; 50(5): 869 - 876. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]

				A. M. Dart, C. D. Gatzka, B. A. Kingwell, K. Willson, J. D. Cameron, Y.-L. Liang, K. L. Berry, L. M.H. Wing, C. M. Reid, P. Ryan, et al. Brachial Blood Pressure But Not Carotid Arterial Waveforms Predict Cardiovascular Events in Elderly Female Hypertensives Hypertension, April 1, 2006; 47(4): 785 - 790. [Abstract] [Full Text] [PDF]

				C. E. Barlow, M. J. LaMonte, S. J. FitzGerald, J. B. Kampert, J. L. Perrin, and S. N. Blair Cardiorespiratory Fitness Is an Independent Predictor of Hypertension Incidence among Initially Normotensive Healthy Women Am. J. Epidemiol., January 15, 2006; 163(2): 142 - 150. [Abstract] [Full Text] [PDF]

				T. J. Wang, J. C. Evans, J. B. Meigs, N. Rifai, C. S. Fox, R. B. D'Agostino, D. Levy, and R. S. Vasan Low-Grade Albuminuria and the Risks of Hypertension and Blood Pressure Progression Circulation, March 22, 2005; 111(11): 1370 - 1376. [Abstract] [Full Text] [PDF]

				R. S. Vasan, L. M. Sullivan, P. W.F. Wilson, C. T. Sempos, J. Sundstrom, W. B. Kannel, D. Levy, and R. B. D'Agostino Relative Importance of Borderline and Elevated Levels of Coronary Heart Disease Risk Factors Ann Intern Med, March 15, 2005; 142(6): 393 - 402. [Abstract] [Full Text] [PDF]

				I. Karp, M. Abrahamowicz, G. Bartlett, and L. Pilote Updated Risk Factor Values and the Ability of the Multivariable Risk Score to Predict Coronary Heart Disease Am. J. Epidemiol., October 1, 2004; 160(7): 707 - 716. [Abstract] [Full Text] [PDF]

				W. B. Kannel, R. S. Vasan, and D. Levy Is the Relation of Systolic Blood Pressure to Risk of Cardiovascular Disease Continuous and Graded, or Are There Critical Values? Hypertension, October 1, 2003; 42(4): 453 - 456. [Full Text] [PDF]

				P. Greenland, M. D. Knoll, J. Stamler, J. D. Neaton, A. R. Dyer, D. B. Garside, and P. W. Wilson Major Risk Factors as Antecedents of Fatal and Nonfatal Coronary Heart Disease Events JAMA, August 20, 2003; 290(7): 891 - 897. [Abstract] [Full Text] [PDF]

				J. G. Douglas, G. L. Bakris, M. Epstein, K. C. Ferdinand, C. Ferrario, J. M. Flack, K. A. Jamerson, W. E. Jones, J. Haywood, R. Maxey, et al. Management of High Blood Pressure in African Americans: Consensus Statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks Arch Intern Med, March 10, 2003; 163(5): 525 - 541. [Full Text] [PDF]

				D. W. Jones, L. J. Appel, S. G. Sheps, E. J. Roccella, and C. Lenfant Measuring Blood Pressure Accurately: New and Persistent Challenges JAMA, February 26, 2003; 289(8): 1027 - 1030. [Full Text] [PDF]