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The Johns Hopkins Precursors Study

Nae-Yuh Wang, PhD; J. Hunter Young, MD, MHS; Lucy A. Meoni, ScM; Daniel E. Ford, MD, MPH; Thomas P. Erlinger, MD, MPH; Michael J. Klag, MD, MPH

Arch Intern Med. 2008;168(6):643-648.

Background  Parental hypertension is used to classify hypertension risk in young adults, but the long-term association of parental hypertension with blood pressure (BP) change and risk of hypertension over the adult life span has not been well studied.

Methods  We examined the association of parental hypertension with BP change and hypertension risk from young adulthood through the ninth decade of life in a longitudinal cohort of 1160 male former medical students with 54 years of follow-up.

Results  In mixed-effects models using 29 867 BP measurements, mean systolic and diastolic BP readings were significantly higher at baseline among participants with parental hypertension. The rate of annual increase was slightly higher for systolic (0.03 mm Hg, P = .04), but not diastolic, BP in those with parental hypertension. After adjustment for baseline systolic and diastolic BP and time-dependent covariates—body mass index, alcohol consumption, coffee drinking, physical activity, and cigarette smoking—the hazard ratio (95% confidence interval [CI]) of hypertension development was 1.5 (1.2-2.0) for men with maternal hypertension only, 1.8 (1.4-2.4) for men with paternal hypertension only, and 2.4 (1.8-3.2) for men with hypertension in both parents compared with men whose parents never developed hypertension. Early-onset (at age 55 years) hypertension in both parents imparted a 6.2-fold higher adjusted risk (95% CI, 3.6-10.7) for the development of hypertension throughout adult life and a 20.0-fold higher adjusted risk (95% CI, 8.4-47.9) at the age of 35 years.

Conclusion  Hypertension in both mothers and fathers has a strong independent association with elevated BP levels and incident hypertension over the course of adult life.

Author Affiliations: Departments of Medicine (Drs Wang, Young, Ford, Erlinger, and Klag and Ms Meoni), Epidemiology (Drs Young, Ford, and Klag), Health Policy and Management (Drs Ford and Klag), and Biostatistics (Ms Meoni), The Johns Hopkins University School of Medicine and The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Dr Erlinger is now with the Department of Medicine, Seton Family of Hospitals, Austin, Texas.