Antecedent blood pressure and risk of cardiovascular disease: the Framingham Heart Study

Casual blood pressure (BP) is a powerful predictor of risk of cardiovascular disease (CVD), but a single BP determination may not accurately reflect the residual impact of antecedent BP levels on vascular risk. It is unclear whether time-averaged past BP measures incrementally improve CVD risk assessment.

We used sex- and age-specific multivariable Cox regression to evaluate the association of current BP (at baseline), recent antecedent BP (average of readings for all available examinations 1 to 10 years before baseline), and remote antecedent BP (average for all available examinations 11 to 20 years before baseline) with the 10-year risk of CVD in 2313 Framingham Study subjects (910 men, 1403 women) free of CVD at baseline. During follow-up, 899 incident initial CVD events were observed (479 in women). In multivariable models incorporating established CVD risk factors, recent and remote antecedent BP predicted CVD risk incrementally over current BP. This effect was consistent in multiple subgroups: men and women, older and younger age groups, and lower and higher BP groups. The relations of antecedent BP to CVD risk were consistent for systolic BP, diastolic BP, and pulse pressure.

Antecedent BP is an important determinant of future risk of CVD events above and beyond current BP. When available, use of long-term average BP may improve the prognostic utility of conventional CVD risk prediction that is based on current BP. Our findings suggest that effective prevention of CVD requires adequate control of BP throughout life.