(Circulation. 1997;96:308-315.)
© 1997 American Heart Association, Inc.
Articles |
Hemodynamic Patterns of Age-Related Changes in Blood Pressure
The Framingham Heart Study
From the Heart Disease Prevention Program, University of California, Irvine (S.S.F, W.G., N.D.W.); the Framingham Heart Study, Framingham, Mass (M.G.L., W.B.K., D.L.); The National Heart, Lung and Blood Institute, Bethesda, Md (D.L.); and Brookdale Hospital Medical Center, Brooklyn, NY (M.A.W.).
Correspondence to Dr Franklin, UCI Heart Disease Prevention Program, C240 Medical Sciences, University of California Irvine, Irvine, CA 92697.
Background We attempted to characterize age-related changes in blood pressure in both normotensive and untreated hypertensive subjects in a population-based cohort from the original Framingham Heart Study and to infer underlying hemodynamic mechanisms.
Methods and Results A total of 2036 participants were divided into four groups according to their systolic blood pressure (SBP) at biennial examination 10, 11, or 12. After excluding subjects receiving antihypertensive drug therapy, up to 30 years of data on normotensive and untreated hypertensive subjects from biennial examinations 2 through 16 were used. Regressions of blood pressure versus age within individual subjects produced slope and curvature estimates that were compared with the use of ANOVA among the four SBP groups. There was a linear rise in SBP from age 30 through 84 years and concurrent increases in diastolic blood pressure (DBP) and mean arterial pressure (MAP); after age 50 to 60 years, DBP declined, pulse pressure (PP) rose steeply, and MAP reached an asymptote. Neither the fall in DBP nor the rise in PP was influenced significantly by removal of subsequent deaths and subjects with nonfatal myocardial infarction or heart failure. Age-related linear increases in SBP, PP, and MAP, as well as the early rise and late fall in DBP, were greatest for subjects with the highest baseline SBP; this represents a divergent rather than parallel tracking pattern.
Conclusions The late fall in DBP after age 60 years, associated with a continual rise in SBP, cannot be explained by "burned out" diastolic hypertension or by "selective survivorship" but is consistent with increased large artery stiffness. Higher SBP, left untreated, may accelerate large artery stiffness and thus perpetuate a vicious cycle.
Key Words: blood pressure • hypertension • aging • epidemiology • physiology
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A. Benetos Does Blood Pressure Control Contribute to a More Successful Aging? Hypertension, August 1, 2005; 46(2): 261 - 262. [Full Text] [PDF]
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M. Zureik, P. Galan, S. Bertrais, D. Courbon, S. Czernichow, J. Blacher, P. Ducimetiere, M. E. Safar, and S. Hercberg Parental Longevity and 7-Year Changes in Blood Pressures in Adult Offspring Hypertension, August 1, 2005; 46(2): 287 - 294. [Abstract] [Full Text] [PDF]
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D. M. Lloyd-Jones, J. C. Evans, and D. Levy Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community JAMA, July 27, 2005; 294(4): 466 - 472. [Abstract] [Full Text] [PDF]
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M. T. Schram, C. G. Schalkwijk, A. H. Bootsma, J. H. Fuller, N. Chaturvedi, C. D.A. Stehouwer, and on behalf of the EURODIAB Prospective Complication Advanced Glycation End Products Are Associated With Pulse Pressure in Type 1 Diabetes: The EURODIAB Prospective Complications Study Hypertension, July 1, 2005; 46(1): 232 - 237. [Abstract] [Full Text] [PDF]
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M. F. O'Rourke and M. E. Safar Relationship Between Aortic Stiffening and Microvascular Disease in Brain and Kidney: Cause and Logic of Therapy Hypertension, July 1, 2005; 46(1): 200 - 204. [Abstract] [Full Text] [PDF]
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C. M. McEniery, Yasmin, S. Wallace, K. Maki-Petaja, B. McDonnell, J. E. Sharman, C. Retallick, S. S. Franklin, M. J. Brown, R. C. Lloyd, et al. Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults Hypertension, July 1, 2005; 46(1): 221 - 226. [Abstract] [Full Text] [PDF]
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J.-G. Wang, J. A. Staessen, S. S. Franklin, R. Fagard, and F. Gueyffier Systolic and Diastolic Blood Pressure Lowering as Determinants of Cardiovascular Outcome Hypertension, May 1, 2005; 45(5): 907 - 913. [Abstract] [Full Text] [PDF]
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J. C. Verhave, P. Fesler, G. du Cailar, J. Ribstein, M. E. Safar, and A. Mimran Elevated Pulse Pressure Is Associated With Low Renal Function in Elderly Patients With Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 586 - 591. [Abstract] [Full Text] [PDF]
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M. F. O'Rourke and W. W. Nichols Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase With Age and Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 652 - 658. [Full Text] [PDF]
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P. Verdecchia and F. Angeli Natural History of Hypertension Subtypes Circulation, March 8, 2005; 111(9): 1094 - 1096. [Full Text] [PDF]
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S. S. Franklin, J. R. Pio, N. D. Wong, M. G. Larson, E. P. Leip, R. S. Vasan, and D. Levy Predictors of New-Onset Diastolic and Systolic Hypertension: The Framingham Heart Study Circulation, March 8, 2005; 111(9): 1121 - 1127. [Abstract] [Full Text] [PDF]
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S. S. Franklin Arterial Stiffness and Hypertension: A Two-Way Street? Hypertension, March 1, 2005; 45(3): 349 - 351. [Full Text] [PDF]
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D. C. Haas, G. L. Foster, F. J. Nieto, S. Redline, H. E. Resnick, J. A. Robbins, T. Young, and T. G. Pickering Age-Dependent Associations Between Sleep-Disordered Breathing and Hypertension: Importance of Discriminating Between Systolic/Diastolic Hypertension and Isolated Systolic Hypertension in the Sleep Heart Health Study Circulation, February 8, 2005; 111(5): 614 - 621. [Abstract] [Full Text] [PDF]
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J. W.J. Vriend, A. H. Zwinderman, E. de Groot, J. J.P. Kastelein, B. J. Bouma, and B. J.M. Mulder Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation Eur. Heart J., January 1, 2005; 26(1): 84 - 90. [Abstract] [Full Text] [PDF]
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 S. Nakano, K. Konishi, K. Furuya, K. Uehara, M. Nishizawa, A. Nakagawa, T. Kigoshi, and K. Uchida A Prognostic Role of Mean 24-h Pulse Pressure Level for Cardiovascular Events in Type 2 Diabetic Subjects Under 60 Years of Age Diabetes Care, January 1, 2005; 28(1): 95 - 100. [Abstract] [Full Text] [PDF]
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K. Miura, Y. Soyama, Y. Morikawa, M. Nishijo, Y. Nakanishi, Y. Naruse, K. Yoshita, S. Kagamimori, and H. Nakagawa Comparison of Four Blood Pressure Indexes for the Prediction of 10-Year Stroke Risk in Middle-Aged and Older Asians Hypertension, November 1, 2004; 44(5): 715 - 720. [Abstract] [Full Text] [PDF]
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M. Ronnback, J. Fagerudd, C. Forsblom, K. Pettersson-Fernholm, A. Reunanen, P.-H. Groop, and on behalf of the Finnish Diabetic Nephropathy Stu Altered Age-Related Blood Pressure Pattern in Type 1 Diabetes Circulation, August 31, 2004; 110(9): 1076 - 1082. [Abstract] [Full Text] [PDF]
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S. S. Najjar, S. P. Schulman, G. Gerstenblith, J. L. Fleg, D. A. Kass, F. O'Connor, L. C. Becker, and E. G. Lakatta Age and gender affect ventricular-vascular coupling during aerobic exercise J. Am. Coll. Cardiol., August 4, 2004; 44(3): 611 - 617. [Abstract] [Full Text] [PDF]
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J. N. Cohn, A. A. Quyyumi, N. K. Hollenberg, and K. A. Jamerson Surrogate Markers for Cardiovascular Disease: Functional Markers Circulation, June 29, 2004; 109(25_suppl_1): IV-31 - IV-46. [Full Text] [PDF]
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 A. L. Pauca, N. D. Kon, and M. F. O'Rourke The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients Br. J. Anaesth., May 1, 2004; 92(5): 651 - 657. [Abstract] [Full Text] [PDF]
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 Yasmin, C. M. McEniery, S. Wallace, I. S. Mackenzie, J. R. Cockcroft, and I. B. Wilkinson C-Reactive Protein Is Associated With Arterial Stiffness in Apparently Healthy Individuals Arterioscler Thromb Vasc Biol, May 1, 2004; 24(5): 969 - 974. [Abstract] [Full Text]
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A. M. Dart, C. D. Gatzka, J. D. Cameron, B. A. Kingwell, Y.-L. Liang, K. L. Berry, C. M. Reid, and G. L. Jennings Large Artery Stiffness Is Not Related to Plasma Cholesterol in Older Subjects with Hypertension Arterioscler Thromb Vasc Biol, May 1, 2004; 24(5): 962 - 968. [Abstract] [Full Text]
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P. J. Mason, J. E. Manson, H. D. Sesso, C. M. Albert, M. J. Chown, N. R. Cook, P. Greenland, P. M Ridker, and R. J. Glynn Blood Pressure and Risk of Secondary Cardiovascular Events in Women: The Women's Antioxidant Cardiovascular Study (WACS) Circulation, April 6, 2004; 109(13): 1623 - 1629. [Abstract] [Full Text] [PDF]
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S. J. Howell, J. W. Sear, and P. Foex Hypertension, hypertensive heart disease and perioperative cardiac risk{dagger} Br. J. Anaesth., April 1, 2004; 92(4): 570 - 583. [Abstract] [Full Text] [PDF]
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M. E. Safar, M. Lajemi, A. Rudnichi, R. Asmar, and A. Benetos Angiotensin-Converting Enzyme D/I Gene Polymorphism and Age-Related Changes in Pulse Pressure in Subjects with Hypertension Arterioscler Thromb Vasc Biol, April 1, 2004; 24(4): 782 - 786. [Abstract] [Full Text] [PDF]
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