You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 275 No. 20, May 22, 1996 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Original Contributions
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati
What's this?

The Progression From Hypertension to Congestive Heart Failure

Daniel Levy, MD; Martin G. Larson, ScD; Ramachandran S. Vasan, MD; William B. Kannel, MD, MPH; Kalon K. L. Ho, MD, MSc

JAMA. 1996;275(20):1557-1562.


Abstract

Objective.
—To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects.

Design.
—Inception cohort study.

Setting.
—General community.

Participants.
—Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970.

Exposure Measures.
—Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations.

Outcome Measure.
—The development of CHF.

Results.
—A total of 5143 eligible subjects contributed 72422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years.

Conclusions.
—Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.

(JAMA. 1996;275:1557-1562)



Author Affiliations

From the Framingham (Mass) Heart Study (Drs Levy, Larson, and Vasan); the National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Levy); the Section of Epidemiology and Preventive Medicine, Boston (Mass) University School of Medicine (Drs Levy, Larson, and Kannel); and the Divisions of Cardiology (Drs Levy and Ho) and Clinical Epidemiology (Dr Levy), Beth Israel Hospital, Boston.


Footnotes

Reprints: Daniel Levy, MD, Framingham Heart Study, 5 Thurber St, Framingham, MA 01701.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Regional left ventricular distribution of abnormal segmental relaxation evaluated by strain echocardiography and the incremental value over annular diastolic velocities in hypertensive patients with normal global diastolic function
Pavlopoulos and Nihoyannopoulos
Eur J Echocardiogr 2009;10:654-662.
ABSTRACT | FULL TEXT  

Baseline factors associated with congestive heart failure in patients receiving etoricoxib or diclofenac: multivariate analysis of the MEDAL program
Krum et al.
Eur J Heart Fail 2009;11:542-550.
ABSTRACT | FULL TEXT  

Predictors of Heart Failure in Patients With Stable Coronary Artery Disease: A PEACE Study
Lewis et al.
Circ Heart Fail 2009;2:209-216.
ABSTRACT | FULL TEXT  

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
Hunt et al.
J Am Coll Cardiol 2009;53:e1-e90.
FULL TEXT  

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
2005 WRITING COMMITTEE MEMBERS et al.
Circulation 2009;119:e391-e479.
FULL TEXT  

Biochemical markers of myocardial remodelling in hypertensive heart disease
Gonzalez et al.
Cardiovasc Res 2009;81:509-518.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT  

The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study.
Bluemke et al.
J Am Coll Cardiol 2008;52:2148-2155.
ABSTRACT | FULL TEXT  

Autophagy in Load-Induced Heart Disease
Rothermel and Hill
Circ. Res. 2008;103:1363-1369.
ABSTRACT | FULL TEXT  

Long-Term Trends in the Incidence of Heart Failure After Myocardial Infarction
Velagaleti et al.
Circulation 2008;118:2057-2062.
ABSTRACT | FULL TEXT  

Is it only diastolic dysfunction? Segmental relaxation patterns and longitudinal systolic deformation in systemic hypertension
Pavlopoulos et al.
Eur J Echocardiogr 2008;9:741-747.
ABSTRACT | FULL TEXT  

The evolution of diastolic dysfunction in the hypertensive disease
Pavlopoulos et al.
Eur J Echocardiogr 2008;9:772-778.
ABSTRACT | FULL TEXT  

Differences in the Incidence of Congestive Heart Failure by Ethnicity: The Multi-Ethnic Study of Atherosclerosis
Bahrami et al.
Arch Intern Med 2008;168:2138-2145.
ABSTRACT | FULL TEXT  

Chronic Intake of a Phytochemical-Enriched Diet Reduces Cardiac Fibrosis and Diastolic Dysfunction Caused by Prolonged Salt-Sensitive Hypertension
Seymour et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:1034-1042.
ABSTRACT | FULL TEXT  

QT Dispersion and Left Ventricular Hypertrophy in Elderly Hypertensive and Normotensive Patients
Dimopoulos et al.
ANGIOLOGY 2008;59:605-612.
ABSTRACT  

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Authors/Task Force Members et al.
Eur Heart J 2008;29:2388-2442.
FULL TEXT  

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Dickstein et al.
Eur J Heart Fail 2008;10:933-989.
FULL TEXT  

Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension: Insights From a Meta-Analysis
Bangalore et al.
J Am Coll Cardiol 2008;52:1062-1072.
ABSTRACT | FULL TEXT  

Hypertension, Heart Failure, and Beta-Adrenergic Blocking Drugs
Fowler
J Am Coll Cardiol 2008;52:1073-1075.
FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
Circulation 2008;118:1080-1111.
FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
J Am Coll Cardiol 2008;52:686-717.
FULL TEXT  

Incident Heart Failure Prediction in the Elderly: The Health ABC Heart Failure Score
Butler et al.
Circ Heart Fail 2008;1:125-133.
ABSTRACT | FULL TEXT  

Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT | FULL TEXT  

Novel Metabolic Risk Factors for Incident Heart Failure and Their Relationship With Obesity: The MESA (Multi-Ethnic Study of Atherosclerosis) Study
Bahrami et al.
J Am Coll Cardiol 2008;51:1775-1783.
ABSTRACT | FULL TEXT  

Cardiac Plasticity
Hill and Olson
NEJM 2008;358:1370-1380.
FULL TEXT  

Left ventricular mass predicts heart failure not related to previous myocardial infarction: the Cardiovascular Health Study
de Simone et al.
Eur Heart J 2008;29:741-747.
ABSTRACT | FULL TEXT  

Gender related differences in patients presenting with acute heart failure. Results from EuroHeart Failure Survey II
Nieminen et al.
Eur J Heart Fail 2008;10:140-148.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT  

A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study
Parikh et al.
ANN INTERN MED 2008;148:102-110.
ABSTRACT | FULL TEXT  

Progressive Diastolic Dysfunction in the Female mRen(2).Lewis Rat: Influence of Salt and Ovarian Hormones
Groban et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:3-11.
ABSTRACT | FULL TEXT  

Inadequate Control of Hypertension in US Adults With Cardiovascular Disease Comorbidities in 2003-2004
Wong et al.
Arch Intern Med 2007;167:2431-2436.
ABSTRACT | FULL TEXT  

Arterial aging: pathophysiological principles
O'Rourke
Vasc Med 2007;12:329-341.
ABSTRACT  

Antecedent Blood Pressure, Body Mass Index, and the Risk of Incident Heart Failure in Later Life
Lee et al.
Hypertension 2007;50:869-876.
ABSTRACT | FULL TEXT  

European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts)
Authors/Task Force Members et al.
Eur Heart J 2007;28:2375-2414.
FULL TEXT  

Regression of Electrocardiographic Left Ventricular Hypertrophy Is Associated with Less Hospitalization for Heart Failure in Hypertensive Patients
Okin et al.
ANN INTERN MED 2007;147:311-319.
ABSTRACT | FULL TEXT  

Clinical epidemiology of heart failure
Mosterd and Hoes
Heart 2007;93:1137-1146.
FULL TEXT  

Congestive heart failure is a rare event in patients receiving imatinib therapy
Atallah et al.
Blood 2007;110:1233-1237.
ABSTRACT | FULL TEXT  

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
Rosendorff et al.
Hypertension 2007;50:e28-e55.
FULL TEXT  

Mechanical Factors in Arterial Aging: A Clinical Perspective
O'Rourke and Hashimoto
J Am Coll Cardiol 2007;50:1-13.
ABSTRACT | FULL TEXT  

Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men
Ingelsson et al.
Eur Heart J 2007;28:1739-1745.
ABSTRACT | FULL TEXT  

Cardiomyocyte-restricted restoration of nitric oxide synthase 3 attenuates left ventricular remodeling after chronic pressure overload
Buys et al.
Am. J. Physiol. Heart Circ. Physiol. 2007;293:H620-H627.
ABSTRACT | FULL TEXT  

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)
Authors/Task Force Members: et al.
Eur Heart J 2007;0:ehm236v1-75.
FULL TEXT  

Predictive Utility of Pulse Pressure and Other Blood Pressure Measures for Cardiovascular Outcomes
Mosley et al.
Hypertension 2007;49:1256-1264.
ABSTRACT | FULL TEXT  

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
Rosendorff et al.
Circulation 2007;115:2761-2788.
FULL TEXT  

EGCG, a green tea polyphenol, improves endothelial function and insulin sensitivity, reduces blood pressure, and protects against myocardial I/R injury in SHR
Potenza et al.
Am. J. Physiol. Endocrinol. Metab. 2007;292:E1378-E1387.
ABSTRACT | FULL TEXT  

Cardiac response to pressure overload in 129S1/SvImJ and C57BL/6J mice: temporal- and background-dependent development of concentric left ventricular hypertrophy
Barrick et al.
Am. J. Physiol. Heart Circ. Physiol. 2007;292:H2119-H2130.
ABSTRACT | FULL TEXT  

Enhanced cardiovascular morbidity and mortality during rhythm control treatment in persistent atrial fibrillation in hypertensives: data of the RACE study
Rienstra et al.
Eur Heart J 2007;28:741-751.
ABSTRACT | FULL TEXT  

A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction
Vazir et al.
Eur J Heart Fail 2007;9:243-250.
ABSTRACT | FULL TEXT  

Lercanidipine in the Treatment of Hypertension
Beckey et al.
The Annals of Pharmacotherapy 2007;41:465-473.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT  

Sleep disturbances independently predict heart failure in overweight middle-aged men
Ingelsson et al.
Eur J Heart Fail 2007;9:184-190.
ABSTRACT | FULL TEXT  

Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey
Li et al.
J. Epidemiol. Community Health 2007;61:67-73.
ABSTRACT | FULL TEXT  

Metabolic Risk Factors for Stroke and Transient Ischemic Attacks in Middle-Aged Men: A Community-Based Study With Long-Term Follow-Up
Wiberg et al.
Stroke 2006;37:2898-2903.
ABSTRACT | FULL TEXT  

Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure.
Gheorghiade et al.
JAMA 2006;296:2217-2226.
ABSTRACT | FULL TEXT  

Systolic and nonsystolic heart failure: equally serious threats.
Hildebrandt
JAMA 2006;296:2259-2260.
FULL TEXT  

Gender-Specific Risk Stratification With B-Type Natriuretic Peptide Levels in Patients With Acute Dyspnea: Insights From the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation Study
Christ et al.
J Am Coll Cardiol 2006;48:1808-1812.
ABSTRACT | FULL TEXT  

Abnormal diastolic currents in ventricular myocytes from spontaneous hypertensive heart failure rats
Sridhar et al.
Am. J. Physiol. Heart Circ. Physiol. 2006;291:H2192-H2198.
ABSTRACT | FULL TEXT  

A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure
Gustafsson et al.
Heart 2006;92:1430-1433.
ABSTRACT | FULL TEXT  

Metabolic syndrome and risk for heart failure in middle-aged men
Ingelsson et al.
Heart 2006;92:1409-1413.
ABSTRACT | FULL TEXT  

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction
Moller et al.
Circulation 2006;114:438-444.
FULL TEXT  

Diurnal blood pressure pattern and risk of congestive heart failure.
Ingelsson et al.
JAMA 2006;295:2859-2866.
ABSTRACT | FULL TEXT  

Blood Pressure Reduction Is Not the Only Determinant of Outcome
Sever et al.
Circulation 2006;113:2754-2774.
FULL TEXT  

Review: From Hypertension to Heart Failure -- Are There Better Primary Prevention Strategies?
Meredith and Ostergren
Journal of Renin-Angiotensin-Aldosterone System 2006;7:64-73.
ABSTRACT  

Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Davis et al.
Circulation 2006;113:2201-2210.
ABSTRACT | FULL TEXT  

Matrix Metalloproteinases/Tissue Inhibitors of Metalloproteinases: Relationship Between Changes in Proteolytic Determinants of Matrix Composition and Structural, Functional, and Clinical Manifestations of Hypertensive Heart Disease
Ahmed et al.
Circulation 2006;113:2089-2096.
ABSTRACT | FULL TEXT  

Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology
Stramba-Badiale et al.
Eur Heart J 2006;27:994-1005.
ABSTRACT | FULL TEXT  

Hypertension and Smoking Are Associated With Reduced Regional Left Ventricular Function in Asymptomatic Individuals: The Multi-Ethnic Study of Atherosclerosis
Rosen et al.
J Am Coll Cardiol 2006;47:1150-1158.
ABSTRACT | FULL TEXT  

Use of Valsartan in Post-Myocardial Infarction and Heart Failure Patients
Liu et al.
Journal of Renin-Angiotensin-Aldosterone System 2006;7:S19-S22.
ABSTRACT  

Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT  

Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age
Lloyd-Jones et al.
Circulation 2006;113:791-798.
ABSTRACT | FULL TEXT  

Electrocardiographic Strain Pattern and Prediction of New-Onset Congestive Heart Failure in Hypertensive Patients: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study
Okin et al.
Circulation 2006;113:67-73.
ABSTRACT | FULL TEXT  

Novel Metabolic Risk Factors for Heart Failure
Ingelsson et al.
J Am Coll Cardiol 2005;46:2054-2060.
ABSTRACT | FULL TEXT  

Habitual Caffeine Intake and the Risk of Hypertension in Women
Winkelmayer et al.
JAMA 2005;294:2330-2335.
ABSTRACT | FULL TEXT  

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)
Developed in Collaboration With the American Colle et al.
J Am Coll Cardiol 2005;46:1116-1143.
FULL TEXT  

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society
Hunt et al.
Circulation 2005;112:1825-1852.
FULL TEXT  

Is hypertension a predictor for heart failure? A cross cultural comparison over a 10-year period
Bener et al.
Eur J Heart Fail 2005;7:784-786.
ABSTRACT | FULL TEXT  

Insulin Resistance and Risk of Congestive Heart Failure
Ingelsson et al.
JAMA 2005;294:334-341.
ABSTRACT | FULL TEXT  

Does load-induced ventricular hypertrophy progress to systolic heart failure?
Berenji et al.
Am. J. Physiol. Heart Circ. Physiol. 2005;289:H8-H16.
ABSTRACT | FULL TEXT  

Inflammation, as Measured by the Erythrocyte Sedimentation Rate, Is an Independent Predictor for the Development of Heart Failure
Ingelsson et al.
J Am Coll Cardiol 2005;45:1802-1806.
ABSTRACT | FULL TEXT  

Diuretics Are Color Blind
Neaton and Kuller
JAMA 2005;293:1663-1666.
FULL TEXT  

Reduced Left Ventricular Functional Reserve in Hypertensive Patients With Preserved Function at Rest
Kozakova et al.
Hypertension 2005;45:619-624.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1996 American Medical Association. All Rights Reserved.