Published Online
on February 21, 2005

A more recent version of this article appeared on March 8, 2005

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Submitted on July 17, 2004
Revised on October 22, 2004
Accepted on December 20, 2004

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, and 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.).

^* To whom correspondence should be addressed. E-mail: ssfranklinmd{at}earthlink.net.

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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