(Circulation. 1997;96:308-315.)
© 1997 American Heart Association, Inc.
Articles |
Hemodynamic Patterns of Age-Related Changes in Blood Pressure
The Framingham Heart Study
From the Heart Disease Prevention Program, University of California, Irvine (S.S.F, W.G., N.D.W.); the Framingham Heart Study, Framingham, Mass (M.G.L., W.B.K., D.L.); The National Heart, Lung and Blood Institute, Bethesda, Md (D.L.); and Brookdale Hospital Medical Center, Brooklyn, NY (M.A.W.).
Correspondence to Dr Franklin, UCI Heart Disease Prevention Program, C240 Medical Sciences, University of California Irvine, Irvine, CA 92697.
Background We attempted to characterize age-related changes in blood pressure in both normotensive and untreated hypertensive subjects in a population-based cohort from the original Framingham Heart Study and to infer underlying hemodynamic mechanisms.
Methods and Results A total of 2036 participants were divided into four groups according to their systolic blood pressure (SBP) at biennial examination 10, 11, or 12. After excluding subjects receiving antihypertensive drug therapy, up to 30 years of data on normotensive and untreated hypertensive subjects from biennial examinations 2 through 16 were used. Regressions of blood pressure versus age within individual subjects produced slope and curvature estimates that were compared with the use of ANOVA among the four SBP groups. There was a linear rise in SBP from age 30 through 84 years and concurrent increases in diastolic blood pressure (DBP) and mean arterial pressure (MAP); after age 50 to 60 years, DBP declined, pulse pressure (PP) rose steeply, and MAP reached an asymptote. Neither the fall in DBP nor the rise in PP was influenced significantly by removal of subsequent deaths and subjects with nonfatal myocardial infarction or heart failure. Age-related linear increases in SBP, PP, and MAP, as well as the early rise and late fall in DBP, were greatest for subjects with the highest baseline SBP; this represents a divergent rather than parallel tracking pattern.
Conclusions The late fall in DBP after age 60 years, associated with a continual rise in SBP, cannot be explained by "burned out" diastolic hypertension or by "selective survivorship" but is consistent with increased large artery stiffness. Higher SBP, left untreated, may accelerate large artery stiffness and thus perpetuate a vicious cycle.
Key Words: blood pressure • hypertension • aging • epidemiology • physiology
This article has been cited by other articles:
 |
|
 |
|
  A. Flaa, I. K. Eide, S. E. Kjeldsen, and M. Rostrup Sympathoadrenal Stress Reactivity Is a Predictor of Future Blood Pressure: An 18-Year Follow-Up Study Hypertension, August 1, 2008; 52(2): 336 - 341. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Zheng, Z. Sun, J. Li, R. Zhang, X. Zhang, S. Liu, J. Li, C. Xu, D. Hu, and Y. Sun Pulse Pressure and Mean Arterial Pressure in Relation to Ischemic Stroke Among Patients With Uncontrolled Hypertension in Rural Areas of China Stroke, July 1, 2008; 39(7): 1932 - 1937. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Najjar, A. Scuteri, V. Shetty, J. G. Wright, D. C. Muller, J. L. Fleg, H. P. Spurgeon, L. Ferrucci, and E. G. Lakatta Pulse Wave Velocity Is an Independent Predictor of the Longitudinal Increase in Systolic Blood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1377 - 1383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Schaeffner, T. Kurth, T. S. Bowman, R. P. Gelber, and J. M. Gaziano Blood pressure measures and risk of chronic kidney disease in men Nephrol. Dial. Transplant., April 1, 2008; 23(4): 1246 - 1251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Delahousse, M. Chaignon, L. Mesnard, P. Boutouyrie, M. E. Safar, T. Lebret, M. Pastural-Thaunat, L. Tricot, A. Kolko-Labadens, A. Karras, et al. Aortic Stiffness of Kidney Transplant Recipients Correlates with Donor Age J. Am. Soc. Nephrol., April 1, 2008; 19(4): 798 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Dart, B. A. Kingwell, C. D. Gatzka, K. Willson, Y.-L. Liang, K. L. Berry, L. M.H. Wing, C. M. Reid, P. Ryan, L. J. Beilin, et al. Smaller Aortic Dimensions Do Not Fully Account for the Greater Pulse Pressure in Elderly Female Hypertensives Hypertension, April 1, 2008; 51(4): 1129 - 1134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, V. Gudnason, L. J. Launer, T. Aspelund, and T. B. Harris Hemodynamics of Increased Pulse Pressure in Older Women in the Community-Based Age, Gene/Environment Susceptibility-Reykjavik Study Hypertension, April 1, 2008; 51(4): 1123 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Hadji Menopausal symptoms and adjuvant therapy-associated adverse events Endocr. Relat. Cancer, March 1, 2008; 15(1): 73 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Safar Review: Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension Therapeutic Advances in Cardiovascular Disease, February 1, 2008; 2(1): 13 - 24. [Abstract] [PDF]
|
|
|
|
|
|
S. M. Farasat, C. H. Morrell, A. Scuteri, C.-T. Ting, F. C.P. Yin, H. A. Spurgeon, C.-H. Chen, E. G. Lakatta, and S. S. Najjar Pulse Pressure Is Inversely Related to Aortic Root Diameter Implications for the Pathogenesis of Systolic Hypertension Hypertension, February 1, 2008; 51(2): 196 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. I. Parikh, M. J. Pencina, T. J. Wang, E. J. Benjamin, K. J. Lanier, D. Levy, R. B. D'Agostino Sr, W. B. Kannel, and R. S. Vasan A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study Ann Intern Med, January 15, 2008; 148(2): 102 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Liu, W. Zhang, and G. S. Kassab Effects of myocardial constraint on the passive mechanical behaviors of the coronary vessel wall Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H514 - H523. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Nilsson High-normal blood pressure and future risks a new concern for clinicians? Eur. Heart J., December 1, 2007; 28(23): 2832 - 2833. [Full Text] [PDF]
|
|
|
|
|
|
G. Michelson, J. Harazny, R. E. Schmieder, R. Berendes, T. Fiermann, and S. Warntges Fourier Analysis of the Envelope of the Ophthalmic Artery Blood Flow Velocity: Age- and Blood Pressure Related Impact Hypertension, November 1, 2007; 50(5): 964 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Benjo, R. E. Thompson, D. Fine, C. W. Hogue, D. Alejo, A. Kaw, G. Gerstenblith, A. Shah, D. E. Berkowitz, and D. Nyhan Pulse Pressure Is an Age-Independent Predictor of Stroke Development After Cardiac Surgery Hypertension, October 1, 2007; 50(4): 630 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jacobson, C. Yan, Q. Gao, T. Rincon-Skinner, A. Rivera, J. Edwards, A. Huang, G. Kaley, and D. Sun Aging enhances pressure-induced arterial superoxide formation Am J Physiol Heart Circ Physiol, September 1, 2007; 293(3): H1344 - H1350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Zintzaras, G. Kitsios, D. Kent, N. J. Camp, L. Atwood, P. N. Hopkins, and S. C. Hunt Genome-Wide Scans Meta-Analysis for Pulse Pressure Hypertension, September 1, 2007; 50(3): 557 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Chobanian Isolated Systolic Hypertension in the Elderly N. Engl. J. Med., August 23, 2007; 357(8): 789 - 796. [Full Text] [PDF]
|
|
|
|
|
|
C. Rosendorff, H. R. Black, C. P. Cannon, B. J. Gersh, J. Gore, J. L. Izzo Jr, N. M. Kaplan, C. M. O'Connor, P. T. O'Gara, and S. Oparil REPRINT Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention Hypertension, August 1, 2007; 50(2): e28 - e55. [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke and J. Hashimoto Mechanical Factors in Arterial Aging: A Clinical Perspective J. Am. Coll. Cardiol., July 3, 2007; 50(1): 1 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Fantin, A. Mattocks, C. J. Bulpitt, W. Banya, and C. Rajkumar Reply Age Ageing, July 1, 2007; 36(4): 476 - 476. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Mosley II, P. Greenland, D. B. Garside, and D. M. Lloyd-Jones Predictive Utility of Pulse Pressure and Other Blood Pressure Measures for Cardiovascular Outcomes Hypertension, June 1, 2007; 49(6): 1256 - 1264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Mancia, M. Bombelli, R. Facchetti, F. Madotto, G. Corrao, F. Q. Trevano, G. Grassi, and R. Sega Long-Term Prognostic Value of Blood Pressure Variability in the General Population: Results of the Pressioni Arteriose Monitorate e Loro Associazioni Study Hypertension, June 1, 2007; 49(6): 1265 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rosendorff, H. R. Black, C. P. Cannon, B. J. Gersh, J. Gore, J. L. Izzo Jr, N. M. Kaplan, C. M. O'Connor, P. T. O'Gara, and S. Oparil Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention Circulation, May 29, 2007; 115(21): 2761 - 2788. [Full Text] [PDF]
|
|
|
|
 |
|
 H T Ong beta blockers in hypertension and cardiovascular disease BMJ, May 5, 2007; 334(7600): 946 - 949. [Full Text] [PDF]
|
|
|
|
|
|
J. Cameron Ageing and central aortic pulse wave analysis. Commentary on 'Is Augmentation Index a Good Measure of Vascular Stiffness in the Elderly?' by Fantin et al. Age Ageing, January 1, 2007; 36(1): 3 - 5. [Full Text] [PDF]
|
|
|
|
|
|
G. Fernandez-Fresnedo, E. Rodrigo, A. L. M. de Francisco, S. S. de Castro, O. Castaneda, and M. Arias Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S246 - S249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Perez Appraising Adjuvant Aromatase Inhibitor Therapy Oncologist, November 1, 2006; 11(10): 1058 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. van Bemmel, K. Woittiez, G. J. Blauw, F. van der Sman-de Beer, F. W. Dekker, R. G.J. Westendorp, and J. Gussekloo Prospective Study of the Effect of Blood Pressure on Renal Function in Old Age: The Leiden 85-Plus Study J. Am. Soc. Nephrol., September 1, 2006; 17(9): 2561 - 2566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kaufmann, L. M. Bachmann, Y. C. Robert, and M. A. Thiel Ocular Pulse Amplitude in Healthy Subjects as Measured by Dynamic Contour Tonometry. Arch Ophthalmol, August 1, 2006; 124(8): 1104 - 1108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Khan and F. A. McAlister Re-examining the efficacy of {beta}-blockers for the treatment of hypertension: a meta-analysis Can. Med. Assoc. J., June 6, 2006; 174(12): 1737 - 1742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Tsakiris, M. Doumas, D. Lagatouras, G. Vyssoulis, E. Karpanou, N. Nearchou, C. Kouremenou, and P. Skoufas Microalbuminuria Is Determined by Systolic and Pulse Pressure Over a 12-Year Period and Related to Peripheral Artery Disease in Normotensive and Hypertensive Subjects: The Three Areas Study in Greece (TAS-GR) Angiology, May 1, 2006; 57(3): 313 - 320. [Abstract] [PDF]
|
|
|
|
 |
|
 C. M. Masi, L. C. Hawkley, J. D. Berry, and J. T. Cacioppo Estrogen Metabolites and Systolic Blood Pressure in a Population-Based Sample of Postmenopausal Women J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 1015 - 1020. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Li, J.-G. Wang, E. Dolan, P.-J. Gao, H.-F. Guo, T. Nawrot, A. V. Stanton, D.-L. Zhu, E. O'Brien, and J. A. Staessen Ambulatory Arterial Stiffness Index Derived From 24-Hour Ambulatory Blood Pressure Monitoring Hypertension, March 1, 2006; 47(3): 359 - 364. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Dolan, L. Thijs, Y. Li, N. Atkins, P. McCormack, S. McClory, E. O'Brien, J. A. Staessen, and A. V. Stanton Ambulatory Arterial Stiffness Index as a Predictor of Cardiovascular Mortality in the Dublin Outcome Study Hypertension, March 1, 2006; 47(3): 365 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Schulman, L. C. Becker, D. A. Kass, H. C. Champion, M. L. Terrin, S. Forman, K. V. Ernst, M. D. Kelemen, S. N. Townsend, A. Capriotti, et al. L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial JAMA, January 4, 2006; 295(1): 58 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Freitag, R. Peila, K. Masaki, H. Petrovitch, G. W. Ross, L. R. White, and L. J. Launer Midlife Pulse Pressure and Incidence of Dementia: The Honolulu-Asia Aging Study Stroke, January 1, 2006; 37(1): 33 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. McEniery, Yasmin, I. R. Hall, A. Qasem, I. B. Wilkinson, J. R. Cockcroft, and on behalf of the ACCT Investigators Normal Vascular Aging: Differential Effects on Wave Reflection and Aortic Pulse Wave Velocity: The Anglo-Cardiff Collaborative Trial (ACCT) J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1753 - 1760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Natoli, T. L. Medley, A. A. Ahimastos, B. G. Drew, D. J. Thearle, R. J. Dilley, and B. A. Kingwell Sex Steroids Modulate Human Aortic Smooth Muscle Cell Matrix Protein Deposition and Matrix Metalloproteinase Expression Hypertension, November 1, 2005; 46(5): 1129 - 1134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Redfield, S. J. Jacobsen, B. A. Borlaug, R. J. Rodeheffer, and D. A. Kass Age- and Gender-Related Ventricular-Vascular Stiffening: A Community-Based Study Circulation, October 11, 2005; 112(15): 2254 - 2262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Assmann, P. Cullen, T. Evers, D. Petzinna, and H. Schulte Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM Eur. Heart J., October 2, 2005; 26(20): 2120 - 2126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Seubert, F. Xu, J. P. Graves, J. B. Collins, S. O. Sieber, R. S. Paules, D. L. Kroetz, and D. C. Zeldin Differential renal gene expression in prehypertensive and hypertensive spontaneously hypertensive rats Am J Physiol Renal Physiol, September 1, 2005; 289(3): F552 - F561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Najjar, A. Scuteri, and E. G. Lakatta Arterial Aging: Is It an Immutable Cardiovascular Risk Factor? Hypertension, September 1, 2005; 46(3): 454 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Benetos Does Blood Pressure Control Contribute to a More Successful Aging? Hypertension, August 1, 2005; 46(2): 261 - 262. [Full Text] [PDF]
|
|
|
|
|
|
M. Zureik, P. Galan, S. Bertrais, D. Courbon, S. Czernichow, J. Blacher, P. Ducimetiere, M. E. Safar, and S. Hercberg Parental Longevity and 7-Year Changes in Blood Pressures in Adult Offspring Hypertension, August 1, 2005; 46(2): 287 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Lloyd-Jones, J. C. Evans, and D. Levy Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community JAMA, July 27, 2005; 294(4): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Schram, C. G. Schalkwijk, A. H. Bootsma, J. H. Fuller, N. Chaturvedi, C. D.A. Stehouwer, and on behalf of the EURODIAB Prospective Complication Advanced Glycation End Products Are Associated With Pulse Pressure in Type 1 Diabetes: The EURODIAB Prospective Complications Study Hypertension, July 1, 2005; 46(1): 232 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke and M. E. Safar Relationship Between Aortic Stiffening and Microvascular Disease in Brain and Kidney: Cause and Logic of Therapy Hypertension, July 1, 2005; 46(1): 200 - 204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. McEniery, Yasmin, S. Wallace, K. Maki-Petaja, B. McDonnell, J. E. Sharman, C. Retallick, S. S. Franklin, M. J. Brown, R. C. Lloyd, et al. Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults Hypertension, July 1, 2005; 46(1): 221 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-G. Wang, J. A. Staessen, S. S. Franklin, R. Fagard, and F. Gueyffier Systolic and Diastolic Blood Pressure Lowering as Determinants of Cardiovascular Outcome Hypertension, May 1, 2005; 45(5): 907 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Verhave, P. Fesler, G. du Cailar, J. Ribstein, M. E. Safar, and A. Mimran Elevated Pulse Pressure Is Associated With Low Renal Function in Elderly Patients With Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 586 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke and W. W. Nichols Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase With Age and Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 652 - 658. [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia and F. Angeli Natural History of Hypertension Subtypes Circulation, March 8, 2005; 111(9): 1094 - 1096. [Full Text] [PDF]
|
|
|
|
|
|
S. S. Franklin, J. R. Pio, N. D. Wong, M. G. Larson, E. P. Leip, R. S. Vasan, and D. Levy Predictors of New-Onset Diastolic and Systolic Hypertension: The Framingham Heart Study Circulation, March 8, 2005; 111(9): 1121 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Franklin Arterial Stiffness and Hypertension: A Two-Way Street? Hypertension, March 1, 2005; 45(3): 349 - 351. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Haas, G. L. Foster, F. J. Nieto, S. Redline, H. E. Resnick, J. A. Robbins, T. Young, and T. G. Pickering Age-Dependent Associations Between Sleep-Disordered Breathing and Hypertension: Importance of Discriminating Between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study Circulation, February 8, 2005; 111(5): 614 - 621. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W.J. Vriend, A. H. Zwinderman, E. de Groot, J. J.P. Kastelein, B. J. Bouma, and B. J.M. Mulder Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation Eur. Heart J., January 1, 2005; 26(1): 84 - 90. [Abstract] |