Abstract 11411: Parental Age of Hypertension Onset and Risk of Hypertension in the Offspring: The Framingham Heart Study

Abstract

Introduction: Parental hypertension (HTN) is known to predict HTN in offspring. However, the relative impact of objectively diagnosed early- vs. late-onset parental HTN on risk of HTN in the community is unknown. Hypothesis: We hypothesized that parental early- vs. late-onset HTN is associated with a substantially greater risk of HTN in offspring. Methods: We analyzed serially collected blood pressure data in the Original cohort (since 1948) and in the Offspring cohort (since 1971) of Framingham Heart Study participants. We identified 1635 non-hypertensive Offspring (32±9 years, 54% women) with longitudinal blood pressure data available for both parents. We defined HTN onset as blood pressure ≥140/90 mmHg or taking antihypertensive medication at ≥2 consecutive exams, and early-onset HTN as onset age <55 years. We analyzed the risk for HTN in Offspring in relation to their parental HTN status: (1) no parents with HTN (N=107); (2) ≥1 parent with late-onset HTN (N=480); (3) 1 parent with early-onset HTN (N=721); and, (4) both parents with early-onset HTN (N=327). Results: Incident HTN was most common in Offspring whose both parents had early-onset HTN (Figure, log-rank p<0.0001). Incidence rates for HTN per 1000 person-years increased across the 4 groups: 5.9 in group 1, 8.3 in group 2, 11.0 in group 3, and 18.9 in group 4. In a multivariable-adjusted discrete logistic model, Offspring HTN risk increased from group 1 (referent) to group 2 (hazard ratio [HR] 1.50, 95% confidence interval [CI] 0.85-2.68), and from group 3 (HR 2.04, 95% CI 1.18-3.54) to group 4 (HR 3.45, 95% CI 1.93-6.14). In 463 Offspring who developed HTN, a 10-year lower parental age of HTN onset was associated with a 1.28-fold (95% CI 1.02-1.61) greater odds of early-onset HTN. Conclusions: Early-onset and not late-onset HTN in parents is a strong risk factor for HTN in offspring. It may be important to differentiate between early- and late-onset parental HTN when estimating an individual’s HTN risk.