Published Online
on September 24, 2007

A more recent version of this article appeared on November 1, 2007

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Submitted on May 26, 2007
Revised on June 13, 2007

Antecedent Blood Pressure, Body Mass Index, and the Risk of Incident Heart Failure in Later Life

Douglas S. Lee; Joseph M. Massaro; Thomas J. Wang; William B. Kannel; Emelia J. Benjamin; Satish Kenchaiah; Daniel Levy; Ralph B. D’Agostino Sr; and Ramachandran S. Vasan^*

From the Institute for Clinical Evaluative Sciences and University Health Network (D.S.L.), University of Toronto, Toronto, Canada; National Heart, Lung, and Blood Institute's Framingham Heart Study (J.M.M., T.J.W., W.B.K., E.J.B., S.K., D.L., R.B.D., R.S.V.), Framingham, Mass; Mathematics Department (J.M.M., R.B.D.), Boston University, Mass; Cardiology Division (T.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division (S.K.), University of California Irvine Medical Center, Orange; National Heart, Lung, and Blood Institute (D.L.), Bethesda, Md; Cardiology Section (E.J.B., R.S.V.), and Department of Preventive Medicine and Epidemiology (E.J.B., R.S.V.), Boston University School of Medicine and School of Public Health (E.J.B.), Mass.

^* To whom correspondence should be addressed. E-mail: vasan{at}bu.edu.

Abstract—Higher blood pressure and body mass index (BMI) are risk factors for heart failure. It is unknown whether the presence of these risk factors in midadulthood affect the future development of heart failure. In the community-based Framingham Heart Study, we examined the associations of antecedent blood pressure and BMI with heart failure incidence in later life. We studied 3362 participants (57% women; mean age: 62 years) who attended routine examinations between 1969 and 1994 and examined their systolic and diastolic blood pressure, pulse pressure, and BMI at current (baseline), recent (average of readings obtained 1 to 10 years before baseline), and remote (average of readings obtained 11 to 20 years before baseline) time periods. During 67 240 person-years of follow-up, 518 participants (280 women) developed heart failure. Current, recent, and remote systolic pressure; pulse pressure; and BMI were individually associated with incident heart failure (all P<0.001). Recent systolic pressure (hazards ratio [HR] per 1-SD increment: 1.31; 95% CI: 1.11 to 1.55), pulse pressure (HR per 1-SD increment: 1.33; 95% CI: 1.14 to 1.54), and BMI (HR per unit increase: 1.15; 95% CI: 1.08 to 1.23) were associated with heart failure risk even after adjusting for current measures. Similarly, remote systolic pressure (HR per 1 SD: 1.17; 95% CI: 1.04 to 1.31), pulse pressure (HR per 1 SD: 1.17; 95% CI: 1.06 to 1.31), and BMI (HR per unit: 1.09; 95% CI: 1.05 to 1.14) remained associated with incident heart failure after adjusting for current measurements. Higher blood pressure and BMI in midlife are harbingers of increased risk of heart failure in later life. Early risk factor modification may decrease heart failure burden.

Key words: hypertension • blood pressure • obesity • body mass index • congestive heart failure • cohort studies

Find additional patient-related information at:

http://www.americanheart.org/presenter.jhtml?identifier=3052017

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