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(Circulation. 2005;111:1121-1127.)
© 2005 American Heart Association, Inc.

Hypertension

Predictors of New-Onset Diastolic and Systolic Hypertension

The Framingham Heart Study

Stanley S. Franklin, MD; Jose R. Pio, BS; Nathan D. Wong, PhD; Martin G. Larson, ScD; Eric P. Leip, MS; Ramachandran S. Vasan, MD; Daniel Levy, MD

From the Heart Disease Prevention Program, University of California, Irvine (S.S.F., J.R.P., N.D.W.); the Framingham Heart Study, Framingham, Mass (M.G.L., E.P.L., R.S.V., D.L.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).

Correspondence to Stanley S. Franklin, MD, Heart Disease Prevention Program, C240 Medical Sciences, University of California, Irvine, CA 92697. E-mail ssfranklinmd{at}earthlink.net

Received July 17, 2004; revision received October 22, 2004; accepted December 20, 2004.

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.

Methods and 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.

Conclusion— 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.

Key Words: blood pressure • hypertension • aging • obesity • epidemiology

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