Predictors of new-onset diastolic and systolic hypertension - The Framingham heart study

Background - Factors leading differentially to the development of isolated diastolic (IDH), systolic-diastolic (SDH), and isolated systolic ( ISH) hypertension are poorly understood. We examined the relations of blood pressure ( BP) and clinical risk factors to the new onset of the 3 forms of hypertension. Methods and Results - Participants in the Framingham Heart Study were included if they had undergone 2 biennial examinations between 1953 and 1957 and were free of antihypertensive therapy and cardiovascular disease. Compared with optimal BP ( SBP < 120 and DBP < 80 mm Hg), the adjusted hazard ratios (HRs) for developing new-onset IDH over the ensuing 10 years were 2.75 for normal BP, 3.29 for high-normal BP ( both P < 0.0001), 1.31 ( P = 0.40) for SDH, and 0.61 ( P = 0.36) for ISH. The HRs of developing new-onset SDH were 3.32, 7.96, 7.10, and 23.12 for the normal BP, high-normal BP, ISH, and IDH groups, respectively ( all P < 0.0001). The HRs of developing ISH were 3.26 for normal and 4.82 for high-normal BP ( both P < 0.0001), 1.39 ( P = 0.24) for IDH, and 1.69 ( P < 0.01) for SDH. Increased body mass index (BMI) during follow-up predicted new-onset IDH and SDH. Other predictors of IDH were younger age, male sex, and BMI at baseline. Predictors of ISH included older age, female sex, and increased BMI during follow-up. Conclusion - Given the propensity for increased baseline BMI and weight gain to predict new-onset IDH and the high probability of IDH to transition to SDH, it is likely that IDH is not a benign condition. ISH arises more commonly from normal and high-normal BP than from "burned-out" diastolic hypertension.