Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease in Men and Women

Abstract

Abstract-Limited information exists about the consequences of hypertension during adulthood on residual life expectancy with cardiovascular disease. We aimed to analyze the life course of people with high blood pressure levels at age 50 in terms of total life expectancy and life expectancy with and without cardiovascular disease compared with normotensives. We constructed multistate life tables for cardiovascular disease, myocardial infarction, and stroke using data from 3128 participants of the Framingham Heart Study who had their 50th birthday while enrolled in the study. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by categories of blood pressure level and adjusted by age, sex, and confounders. Irrespective of sex, 50-year-old hypertensives compared with normotensives had a shorter life expectancy, a shorter life expectancy free of cardiovascular disease, myocardial infarction, and stroke, and a longer life expectancy lived with these diseases.Normotensive men (22% of men) survived 7.2 years (95% confidence interval, 5.6 to 9.0) longer without cardiovascular disease compared with hypertensives and spent 2.1 (0.9 to 3.4) fewer years of life with cardiovascular disease. Similar differences were observed in women. Compared with hypertensives, total life expectancy was 5.1 and 4.9 years longer for normotensive men and women, respectively. Increased blood pressure in adulthood is associated with large reductions in life expectancy and more years lived with cardiovascular disease. This effect is larger than estimated previously and affects both sexes similarly. Our findings underline the tremendous importance of preventing high blood pressure and its consequences in the population. Key Words: blood pressure Ⅲ cardiovascular diseases E levated blood pressure (BP) is a major modifiable risk factor for cardiovascular disease (CVD) and mortality. 1,2 Suboptimal BP (Ͼ115 mm Hg systolic BP [SBP]) is estimated to be responsible for 62% of cerebrovascular disease and 49% of coronary heart disease. 3 The relationship between BP and CVD risk is continuous and independent of other risk factors. 1,4,5 BP control has been shown to be effective in reducing CVD and mortality, although below expectations from observational evidence. 1,6,7 However, few studies have looked at the impact of BP on life expectancy (LE), 8,9 and none have evaluated its effects on LE with and without CVD. Therefore, whether improving the level of BP in the population will lead to more or fewer years lived with CVD remained uncertain.The answer to this question might seem obvious, but examples from other risk factors such as smoking or obesity show that results can be counterintuitive. Obesity is associated with a shorter LE and an increase in LE with CVD. Therefore, control of obesity would lead to less cardiovascular morbidity (M. Pardo Silva, unpublished data, 2003). Smoking is also associated with shorter LE but with fewer years lived with CVD because smokers, o...

Effects of high-intensity aerobic interval training vs. moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension

“…38 Clinical implications HPT is an important risk factor associated with all-cause and cardiovascular mortality, as well as a greater life expectance without cardiovascular disease. 2,47 Moreover, BP is strong and linearly associated with coronary heart disease and stroke, 2 which are the most common causes of mortality among women. 48 Preventing or delaying the onset of HPT may therefore have a large impact on public health, mainly in individuals at high risk for HPT.…”

Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study

“…Although the high levels of selfreported DM and hypertension control likely reflect a certain degree of subjective reporter bias, our findings support that HRS participants with these conditions are generally under good control; DM and hypertension were associated with only moderate levels of increased risk for mortality and cardiovascular events compared with hazard ratios previously reported for uncontrolled disease. 20, [40][41][42] Other studies evaluating a subset of HRS respondents also found similar moderately increased risks for DM and hypertension. 43,44 *Low and high were determined by whether scores were below or at least equal to the median, respectively † Discrete time-to-event model included psychological groups (based on perceived constraints and health-specific control), main biomedical predictors (diabetes and hypertension), perceived mastery (in quartiles), self-reported heart disease, lung disease, cancer, psychological problems, arthritis, memory difficulties, baseline smoking, vigorous activity more than once a week, difficulty with activities of daily living (ADLs) or instrumental activities of daily living (IADLs), score on the 8-question Centers of Epidemiologic Studies Depression Scale (CESD8), and scores for positive and negative affect; see Methods for full variable definitions ‡ Rate calculated as number of events per 1,000 person-years of follow-up In addition to variables in the basic model, the full model includes self-reported heart disease, lung disease, cancer, psychological problems, arthritis, memory difficulties, baseline smoking, vigorous activity more than once a week, difficulty with activities of daily living (ADLs) or instrumental activities of daily living (IADLs), score on the 8-question Centers of Epidemiologic Studies Depression Scale (CESD8), and scores for positive and negative affect; see Methods for full variable definitions…”

Effect of Race and Ethnicity on Antihypertensive Medication Utilization Among Women in the United States: Study of Women's Health Across the Nation (SWAN)

“…After age 55, women have equal or greater prevalence of HTN compared with men 2. Life expectancy for women with HTN is on average 4.9 years shorter than women with normal blood pressure (BP) at the age of 50 3. The prevalence of HTN among black women in the United States is one of the highest in the world, at more than 40% 1.…”