Abstract P182: Risk for Hypertension Extends Across Generations in the Community: a Multi-generational Cohort Study

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Background: Hypertension is a major risk factor for cardiovascular disease, and parental hypertension is known to predict high blood pressure (BP) in children. However, the extent to which risk for hypertension is conferred across multiple generations, notwithstanding the impact of environmental factors, is unclear. Our objective was therefore to evaluate the degree to which risk for hypertension extends across multiple generations. Methods: We studied three generations of Framingham Heart Study participants with objectively ascertained, uniform BP measurements performed at serial examinations spanning 5 decades: First Generation cohort (1948-2005), Second Generation cohort (1971-2008), and Third Generation cohort (2002-2005). We examined the simultaneous associations of early-onset hypertension (prior to age 55 years) in parents or grandparents with normotension (BP <120/80; reference), prehypertension (BP 120-139/80-89 mmHg), and hypertension (BP ≥140/90 mmHg, or use of antihypertensive medication) in the Third Generation cohort. We estimated odds ratios (OR) and 95% confidence intervals (CI) for prehypertension and hypertension per additional parent or grandparent with early-onset hypertension using multinomial logistic regression adjusting for standard environmental factors. Results: Our final dataset for analyses included BP measurements collected from 2280 First Generation participants (i.e., grandparents), 3122 Second Generation participants (i.e., parents), and 3608 Third Generation participants (mean age 39 years, 53% women). In Third Generation participants, risk for elevated BP was conferred simultaneously by both parental (OR for prehypertension 1.72 [CI, 1.42-2.08]; OR for hypertension 2.22 [CI, 1.72-2.86]) and grandparental (OR for prehypertension 1.24 [CI, 1.05-1.46]; OR for hypertension 1.38 [CI, 1.11-1.73]) early-onset hypertension. In a secondary analysis with a subset of 3319 Third Generation participants with all covariates available, results were also similar in models additionally adjusting for physical activity and daily dietary intake of sodium. Conclusions: A predisposition for developing hypertension is conferred from grandparents to grandchildren, even after adjusting for parental history of hypertension and lifestyle factors. Additional studies are warranted to elucidate how identifying transgenerational risk for early-onset hypertension can improve the care of individuals at risk. Our results also suggest that when assessing an individual’s risk for hypertension, more accurate risk stratification could be achieved by considering both parental and grandparental history of hypertension.