Managing blood pressure, weight in middle age may protect heart in old age

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(NC&T/BU) An increase of just one standard deviation (about 20 mm Hg) in systolic blood pressure at age 50 was associated with a 36 percent higher risk of heart failure over an observation period extending up to 20 years later, said Ramachandran S. Vasan, M.D., senior investigator of the Framingham Heart Study and a professor of medicine at Boston University School of Medicine. A standard deviation (about 15 mm Hg) increase in pulse pressure increased the heart failure risk by 31 percent.

"Every 1 kg/m2 increment in current, recent or remote body mass index (BMI, a measure of body fat) was associated with a 5 to 7 percent increase in the risk of heart failure," Vasan said. "Although hypertension and high BMI are often detected in later life, and are associated with heart failure risk, the effects of these conditions likely begin far earlier in life."

Researchers said the Framingham findings have important public health implications because the development of preventive strategies require a better understanding of the key risk factors for heart failure and the evolution of these risk factors over a person's lifetime.

"This study highlights the importance of maintaining an ideal BMI and blood pressure over the life course of individuals," Vasan said. "We tested the hypothesis that higher levels of blood pressure and BMI in midlife would be powerful determinants of heart failure risk in later life, and that the risk posed by preceding measurements would remain even after accounting for these risk factors measured later in life."

Vasan and colleagues studied 3,362 participants in the Framingham Heart Study who had routine examinations between 1969 and 1994. The federal government's Framingham Heart Study started in 1948, follows a representative sample of 5,209 adult residents and their offspring in Framingham, Mass.

"Current" measurements were defined using data collected at the first biennial examination attended by participants between 1969 and 1994 (referred to as baseline for this investigation) at which blood pressure, pulse pressure, and BMI data were collected. Measurements collected at an examination during the decade preceding that baseline examination were considered "recent" measurements (as opposed to 'current' measurements), and measurements taken 11 to 20 years prior to baseline were referred to as "remote" measurements.

During follow-up, 518 participants developed heart failure for an overall event rate of 0.92 per 100 person years.

Both "recent" and "remote" measurements of systolic blood pressure, pulse pressure and BMI were individually associated with risk of heart failure.

"The prevention of heart failure should begin early in life, and should include screening for elevated blood pressure and BMI," Vasan said. "Failure to identify or treat such modifiable risk factors in early and mid-adulthood may result in the loss of opportunities to reduce the incidence of heart failure in later life."

Regular physical exercise, healthy diet, maintaining an ideal body weight (for a person's height) and periodic check-ups with the primary care physician are some key steps, Vasan said.

The Framingham sample is white, so the ability to generalize to non-white ethnicities is unknown. "But there is no reason to believe that obesity or high blood pressure will pose a lesser hazard in any ethnic group," Vasan said. "Quite to the contrary, blacks seem to have a greater burden of high blood pressure-related diseases."

The American Heart Association estimates that more than 5.2 million Americans have heart failure, and in 2004 almost 58,000 Americans died from it.




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