Abstract P186: Cardiovascular Outcomes Associated With Early- versus Late-onset Hypertension

Abstract

Introduction: It is well known that hypertension confers substantial risk for developing cardiovascular disease (CVD) outcomes when present in either younger or older age. However, there are currently scant data to guide clinicians on the possible importance of distinguishing between the significance of hypertension that develops earlier versus later in life. We conducted an investigation in the original Framingham Heart Study cohort to assess the long-term CVD risks associated with developing early- versus late-onset hypertension over the adult life course. Methods: Assessment of hypertension onset was based on blood pressure (BP) data collected from serial biannual examinations performed from 1948 through 2005. We defined hypertension as BP ≥140/90 mmHg or use of antihypertensive medication on ≥2 consecutively attended examinations. We studied the relation of age-of-onset of hypertension with cause-specific mortality using a case (CVD deaths) versus control (non-CVD deaths) design. We used logistic regression to calculate case-versus-control odds ratios, adjusted for age at death, sex, smoking status, total cholesterol, and diabetes. Results: In 3614 decedents (1151 CVD deaths, including 630 coronary deaths), the odds of CVD death increased linearly with decreasing age of hypertension onset (Figure). Compared to non-hypertensives, hypertension onset at age <45 conferred a 2.2-fold odds of CVD death and 2.3-fold odds of coronary death, whereas hypertension onset at age ≥65 conferred a lower-magnitude 1.5-fold odds of CVD death and 1.4-fold odds of coronary death ( P ≤.002 for differences in odds between hypertension onset at age <45 and ≥65). Conclusions: Early- compared to late-onset hypertension was associated with greater odds of CVD and particularly coronary death. These findings suggest it may be important to distinguish between early- and late-onset hypertension as a specific type of BP trait when estimating risk for CVD outcomes in persons with established hypertension.