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Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study

Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death. Design Multigenerational, prospective cohort study. Setting Framingham Heart Study. Participants Two generations of community dwelling participants w...

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Autores principales: Niiranen, Teemu J, McCabe, Elizabeth L, Larson, Martin G, Henglin, Mir, Lakdawala, Neal K, Vasan, Ramachandran S, Cheng, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430541/
https://www.ncbi.nlm.nih.gov/pubmed/28500036
http://dx.doi.org/10.1136/bmj.j1949
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author Niiranen, Teemu J
McCabe, Elizabeth L
Larson, Martin G
Henglin, Mir
Lakdawala, Neal K
Vasan, Ramachandran S
Cheng, Susan
author_facet Niiranen, Teemu J
McCabe, Elizabeth L
Larson, Martin G
Henglin, Mir
Lakdawala, Neal K
Vasan, Ramachandran S
Cheng, Susan
author_sort Niiranen, Teemu J
collection PubMed
description Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death. Design Multigenerational, prospective cohort study. Setting Framingham Heart Study. Participants Two generations of community dwelling participants with blood pressure measurements performed at serial examinations spanning six decades: 3614 first generation participants with mortality data and 1635 initially non-hypertensive second generation participants with data available on parental blood pressure. Main outcome measures The main outcome measures were relation of parental early onset hypertension (age <55 years) with incidence of hypertension in offspring, using regression analyses, and relation of age at hypertension onset with cause specific mortality using a case (cardiovascular death) versus control (non-cardiovascular death) design. Results In second generation participants, having one or both parents with late onset hypertension did not increase the risk of hypertension compared with having parents with no hypertension; by contrast, the hazard ratios of hypertension were 2.0 (95% confidence interval 1.2 to 3.5) and 3.5 (1.9 to 6.1) in participants with one and both parents with early onset hypertension, respectively. In first generation decedents, 1151 cardiovascular deaths occurred (including 630 coronary deaths). The odds of cardiovascular death increased linearly with decreasing age of hypertension onset (P<0.001 for trend). Compared with non-hypertensive participants, hypertension onset at age <45 years conferred an odds ratios of 2.2 (1.8 to 2.7) for cardiovascular death and 2.3 (1.8 to 2.9) for coronary death, whereas hypertension onset at age ≥65 years conferred a lower magnitude odds ratios of 1.5 (1.2 to 1.9) for cardiovascular death and 1.4 (0.98 to 1.9) for coronary death (P≤0.002 for differences in odds ratios between hypertension onset at age <45 and age ≥65). Conclusions Early onset and not late onset hypertension in parents was strongly associated with hypertension in offspring. In turn, early onset compared with late onset hypertension was associated with greater odds of cardiovascular, and particularly coronary, death. These findings suggest it may be important to distinguish between early onset and late onset hypertension as a familial trait when assessing an individual’s risk for hypertension, and as a specific type of blood pressure trait when estimating risk for cardiovascular outcomes in adults with established hypertension.
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spelling pubmed-54305412017-05-17 Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study Niiranen, Teemu J McCabe, Elizabeth L Larson, Martin G Henglin, Mir Lakdawala, Neal K Vasan, Ramachandran S Cheng, Susan BMJ Research Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death. Design Multigenerational, prospective cohort study. Setting Framingham Heart Study. Participants Two generations of community dwelling participants with blood pressure measurements performed at serial examinations spanning six decades: 3614 first generation participants with mortality data and 1635 initially non-hypertensive second generation participants with data available on parental blood pressure. Main outcome measures The main outcome measures were relation of parental early onset hypertension (age <55 years) with incidence of hypertension in offspring, using regression analyses, and relation of age at hypertension onset with cause specific mortality using a case (cardiovascular death) versus control (non-cardiovascular death) design. Results In second generation participants, having one or both parents with late onset hypertension did not increase the risk of hypertension compared with having parents with no hypertension; by contrast, the hazard ratios of hypertension were 2.0 (95% confidence interval 1.2 to 3.5) and 3.5 (1.9 to 6.1) in participants with one and both parents with early onset hypertension, respectively. In first generation decedents, 1151 cardiovascular deaths occurred (including 630 coronary deaths). The odds of cardiovascular death increased linearly with decreasing age of hypertension onset (P<0.001 for trend). Compared with non-hypertensive participants, hypertension onset at age <45 years conferred an odds ratios of 2.2 (1.8 to 2.7) for cardiovascular death and 2.3 (1.8 to 2.9) for coronary death, whereas hypertension onset at age ≥65 years conferred a lower magnitude odds ratios of 1.5 (1.2 to 1.9) for cardiovascular death and 1.4 (0.98 to 1.9) for coronary death (P≤0.002 for differences in odds ratios between hypertension onset at age <45 and age ≥65). Conclusions Early onset and not late onset hypertension in parents was strongly associated with hypertension in offspring. In turn, early onset compared with late onset hypertension was associated with greater odds of cardiovascular, and particularly coronary, death. These findings suggest it may be important to distinguish between early onset and late onset hypertension as a familial trait when assessing an individual’s risk for hypertension, and as a specific type of blood pressure trait when estimating risk for cardiovascular outcomes in adults with established hypertension. BMJ Publishing Group Ltd. 2017-05-12 /pmc/articles/PMC5430541/ /pubmed/28500036 http://dx.doi.org/10.1136/bmj.j1949 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
Niiranen, Teemu J
McCabe, Elizabeth L
Larson, Martin G
Henglin, Mir
Lakdawala, Neal K
Vasan, Ramachandran S
Cheng, Susan
Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title_full Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title_fullStr Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title_full_unstemmed Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title_short Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study
title_sort heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the framingham heart study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430541/
https://www.ncbi.nlm.nih.gov/pubmed/28500036
http://dx.doi.org/10.1136/bmj.j1949
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