Novel approach to examining first cardiovascular events after hypertension onset

被引:49
作者
Lloyd-Jones, DM
Leip, EP
Larson, MG
Vasan, RS
Levy, D
机构
[1] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA
[2] NHLBI, Framingham Heart Study, NIH, Framingham, MA USA
[3] Boston Univ, Sch Med, Div Epidemiol & Prevent Med, Boston, MA 02118 USA
[4] NHLBI, Bethesda, MD 20892 USA
关键词
hypertension; detection and control; risk factors; cardiovascular diseases;
D O I
10.1161/01.HYP.0000149106.89470.13
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Hypertension confers risk for multiple types of cardiovascular events, but competing risks for these outcomes are unknown. We estimated the competing risks over 12 years after hypertension onset among cases and age-, sex-, and examination-matched controls using competing Cox cumulative incidence and proportional hazards models. We included all Framingham Heart Study subjects examined after 1977 with new-onset hypertension who were free of cardiovascular disease. There were 645 men and 702 women with new-onset hypertension ( mean age: men, 55 +/- 12 years; women, 59 +/- 12 years). Compared with matched nonhypertensive controls, subjects with new-onset hypertension were more likely to experience a cardiovascular event first rather than noncardiovascular death. Among new-onset hypertensives, the 12-year competing cumulative incidence of any cardiovascular end point as a first event in men was 24.7%, compared with 9.8% for noncardiovascular death ( hazards ratio [HR], 2.53; 95% confidence interval [CI], 1.83 to 3.50); in women, the competing incidences were 16.0% versus 10.1%, respectively ( HR, 1.58; 95% CI, 1.13 to 2.20). The most common first major cardiovascular events were hard coronary disease (8.2%) in men and stroke (5.2%) in women. Type and incidence of first cardiovascular events varied by age and severity of hypertension at onset, with stroke predominating among older subjects with new-onset hypertension. After hypertension onset, cardiovascular events are more likely to occur first as opposed to noncardiovascular death. Types of initial events differ by gender, age, and severity of hypertension at onset. These results represent a novel approach to understanding the complications of hypertension and may help target therapies for patients with new-onset hypertension to optimize prevention strategies.
引用
收藏
页码:39 / 45
页数:7
相关论文
共 28 条
[1]  
Abbott R.D., 1987, The Framingham Study: an epidemiological investigation of cardiovascular disease
[2]  
*AM HEART ASS, 2003, HEART DIS STROK STAT
[3]  
[Anonymous], 1991, JAMA, V265, P3255
[4]  
[Anonymous], 1994, BMJ, V308, P81, DOI [10.1136/bmj.308.6921.81, DOI 10.1136/BMJ.308.6921.81]
[5]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[6]   Differential effects of lipid-lowering therapies on stroke prevention - A meta-analysis of randomized trials [J].
Corvol, JC ;
Bouzamondo, A ;
Sirol, M ;
Hulot, JS ;
Sanchez, P ;
Lechat, P .
ARCHIVES OF INTERNAL MEDICINE, 2003, 163 (06) :669-676
[7]  
COX DR, 1972, J R STAT SOC B, V34, P187
[8]   AN APPROACH TO LONGITUDINAL STUDIES IN A COMMUNITY - FRAMINGHAM STUDY [J].
DAWBER, TR ;
KANNEL, WB ;
LYELL, LP .
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 1963, 107 (02) :539-&
[9]   The burden of adult hypertension in the United States 1999 to 2000 - A rising tide [J].
Fields, LE ;
Burt, VL ;
Cutler, JA ;
Hughes, J ;
Roccella, EJ ;
Sorlie, P .
HYPERTENSION, 2004, 44 (04) :398-404
[10]   Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men - A meta-analysis of individual patient data from randomized, controlled trials [J].
Gueyffier, F ;
Boutitie, F ;
Boissel, JP ;
Pocock, S ;
Coope, J ;
Cutler, J ;
Ekbom, T ;
Fagard, R ;
Friedman, L ;
Perry, M ;
Prineas, R ;
Schron, E .
ANNALS OF INTERNAL MEDICINE, 1997, 126 (10) :761-+