Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and Men

TLDR

Lifetime risk is the preferred metric for long‑term hypertension risk, yet its temporal trends remain unclear. The study aimed to estimate residual lifetime hypertension risk in older adults and assess its temporal trends. A community‑based prospective cohort of 1,298 Framingham participants aged 55–65, free of hypertension at baseline, was followed to calculate residual lifetime risk defined by BP ≥ 140/90 mm Hg or antihypertensive use. The study found a 90% residual lifetime risk of hypertension (and stage 1 high blood pressure) in 55‑ and 65‑year‑olds, a 60% chance of antihypertensive use, a 60% higher risk in men versus women in the recent era, a marked decline in stage 2 hypertension risk, underscoring a substantial public‑health burden and the need for primary prevention.

Abstract

ContextThe 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.ObjectivesTo estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk.Design, Setting, and ParticipantsCommunity-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 MeasuresResidual 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.ResultsThe 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.ConclusionThe 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.