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The Framingham Heart Study

Ramachandran S. Vasan, MD; Alexa Beiser, PhD; Sudha Seshadri, MD; Martin G. Larson, ScD; William B. Kannel, MD; Ralph B. D'Agostino, PhD; Daniel Levy, MD

JAMA. 2002;287:1003-1010.

Context  The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown.

Objectives  To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk.

Design, Setting, and Participants  Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998).

Main Outcome Measures  Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications.

Results  The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure.

Conclusion  The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.

Author Affiliations: the National Heart, Lung, and Blood Institute's Framingham Heart Study (Drs Vasan, Seshadri, Larson, Kannel, and Levy), Framingham, Mass; Cardiology Section (Dr Vasan), Preventive Medicine and Epidemiology (Drs Vasan, Larson, Kannel, and Levy), Department of Neurology (Dr Seshadri), School of Medicine, Epidemiology and Biostatistics (Dr Beiser), School of Public Health, and the Department of Mathematics (Dr D'Agostino), Boston University, Boston, Mass; the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Deaconess Medical Center, Boston, Mass (Dr Levy); and the National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Levy).

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