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Circulation. 1997;96:308-315

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(Circulation. 1997;96:308-315.)
© 1997 American Heart Association, Inc.

Articles

Hemodynamic Patterns of Age-Related Changes in Blood Pressure

The Framingham Heart Study

Stanley S. Franklin, MD; William Gustin, IV, BS; Nathan D. Wong, PhD; Martin G. Larson, ScD; Michael A. Weber, MD; William B. Kannel, MD; ; Daniel Levy, MD

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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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.
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P. Verdecchia and F. Angeli
Natural History of Hypertension Subtypes
Circulation, March 8, 2005; 111(9): 1094 - 1096.
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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.
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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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 Eur Heart JHome page
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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 J Am Coll CardiolHome page
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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 Br J AnaesthHome page
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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 Arterioscler. Thromb. Vasc. Bio.Home page
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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 CirculationHome page
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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 Br J AnaesthHome page
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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G. F. Mitchell
Increased Aortic Stiffness: An Unfavorable Cardiorenal Connection
Hypertension, February 1, 2004; 43(2): 151 - 153.
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al.
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Hypertension, December 1, 2003; 42(6): 1206 - 1252.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
J. Oliveira-Filho, S.C.S. Silva, C.C. Trabuco, B.B. Pedreira, E.U. Sousa, and A. Bacellar
Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset
Neurology, October 28, 2003; 61(8): 1047 - 1051.
[Abstract] [Full Text] [PDF]

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 Am. J. Physiol. Heart Circ. Physiol.Home page
M. E. Safar and P. Laurent
Pulse pressure and arterial stiffness in rats: comparison with humans
Am J Physiol Heart Circ Physiol, October 1, 2003; 285(4): H1363 - H1369.
[Full Text] [PDF]

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 Arch SurgHome page
O. O. Aalami, T. D. Fang, H. M. Song, and R. P. Nacamuli
Physiological Features of Aging Persons
Arch Surg, October 1, 2003; 138(10): 1068 - 1076.
[Full Text] [PDF]

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C. Qiu, B. Winblad, J. Fastbom, and L. Fratiglioni
Combined effects of APOE genotype, blood pressure, and antihypertensive drug use on incident AD
Neurology, September 9, 2003; 61(5): 655 - 660.
[Abstract] [Full Text] [PDF]

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 Am J Crit CareHome page
L. G. Futterman and L. Lemberg
The Effects of Aging on Arteries
Am. J. Crit. Care., September 1, 2003; 12(5): 472 - 475.
[Full Text] [PDF]


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