Early-Onset Hypertension Confers Greater Cardiovascular Risk than Late-Onset Hypertension

Summary and Comment |
June 15, 2017

Early-Onset Hypertension Confers Greater Cardiovascular Risk than Late-Onset Hypertension

  1. Paul S. Mueller, MD, MPH, FACP

Early-onset hypertension also is associated with excess hypertension risk in offspring.

  1. Paul S. Mueller, MD, MPH, FACP

Whether early-onset hypertension confers more cardiovascular (CV) risk than does late-onset hypertension is unclear. In this study, investigators used data from 3600 community-dwelling participants in the Framingham Heart Study to determine whether early-onset, compared with late-onset, hypertension is associated with CV-related death. Risk for CV-related death was significantly higher among those with early-onset hypertension (age, <45) than among those without hypertension (odds ratio, 2.19). Notably, as age of hypertension onset rose, risk fell: For example, onset at age ≥65 conferred an OR of 1.47 for CV-related death.

In another analysis, the researchers examined associations between hypertension in first-generation Framingham participants and hypertension in their offspring. Having parents with early-onset hypertension (defined as age, <55) was associated with excess incidence of hypertension, compared with having nonhypertensive parents (adjusted hazard ratio, 2.0 if 1 parent; 3.5 if both parents). In contrast, late-onset hypertension was not associated with excess incidence in offspring.

Comment

In this study, the earlier the hypertension onset, the higher the risk for CV-related death — presumably owing to hypertension's cumulative effects. The authors believe these results probably aren't confounded by antihypertensive drug therapy, given that treatment was uncommon and the drugs had limited efficacy during the first 40 years of the study. In addition, early-onset, but not late-onset, hypertension was associated with development of hypertension in offspring — suggestive of a genetic effect. Clinicians should consider age of hypertension onset and its effects on CV risk, and should advise patients with early-onset hypertension to have their children monitored for developing hypertension.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific Editorial boards Medical Knowledge Self-Assessment Program; MKSAP 18 General Internal Medicine Leadership positions in professional societies American Osler Society (Board of Governors)

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