Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease
Ramachandran S. Vasan, M.D., Martin G. Larson, Sc.D., Eric P. Leip, M.S., Jane C. Evans, Ph.D., Christopher J. O'Donnell, M.D., M.P.H., William B. Kannel, M.D., M.P.H., and Daniel Levy, M.D.
Background Information is limited regarding the risk of cardiovasculardisease in persons with high-normal blood pressure (systolicpressure of 130 to 139 mm Hg, diastolic pressure of 85 to 89mm Hg, or both).
Methods We investigated the association between blood-pressurecategory at base line and the incidence of cardiovascular diseaseon follow-up among 6859 participants in the Framingham HeartStudy who were initially free of hypertension and cardiovasculardisease.
Results A stepwise increase in cardiovascular event rates wasnoted in persons with higher base-line blood-pressure categories.The 10-year cumulative incidence of cardiovascular disease insubjects 35 to 64 years of age who had high-normal blood pressurewas 4 percent (95 percent confidence interval, 2 to 5 percent)for women and 8 percent (95 percent confidence interval, 6 to10 percent) for men; in older subjects (those 65 to 90 yearsold), the incidence was 18 percent (95 percent confidence interval,12 to 23 percent) for women and 25 percent (95 percent confidenceinterval, 17 to 34 percent) for men. As compared with optimalblood pressure, high-normal blood pressure was associated witha risk-factor–adjusted hazard ratio for cardiovasculardisease of 2.5 (95 percent confidence interval, 1.6 to 4.1)in women and 1.6 (95 percent confidence interval, 1.1 to 2.2)in men.
Conclusions High-normal blood pressure is associated with anincreased risk of cardiovascular disease. Our findings emphasizethe need to determine whether lowering high-normal blood pressurecan reduce the risk of cardiovascular disease.
Several epidemiologic studies1,2,3,4,5,6,7 have demonstratedthat systolic and diastolic blood pressures have a "strong,continuous, graded and etiologically significant" positive associationwith cardiovascular-disease outcomes.1 These relations are consistentin both men and women, in young, middle-aged, and older subjects,among different racial and ethnic groups,1,2,3,4,5 and withinand between countries.6,7 Although there is a continuum of cardiovascularrisk across levels of blood pressure,1,2,3,4,5,6,7 the classificationof adults according to blood pressure provides a framework fordifferentiating levels of risk associated with various blood-pressurecategories and for defining treatment thresholds and therapeuticgoals.
According to the classification approaches developed by theJoint National Committee on Prevention, Detection, Evaluation,and Treatment of High Blood Pressure (JNC VI)8 and the WorldHealth Organization and the International Society of Hypertension(WHO-ISH),9 nonhypertensive subjects with a systolic pressureof 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hgare categorized as having high-normal blood pressure. Althoughsubjects with high-normal blood pressure are likely to havean elevated risk of cardiovascular disease (given the continuumof risk), there is a paucity of information regarding the absoluteand relative risks of cardiovascular disease in these persons.Although data on fatal coronary events and strokes in personswith high-normal blood pressure are available,10,11 informationon the risk of nonfatal cardiovascular events among people inthis blood-pressure category is limited. We undertook a prospectiveexamination of the risk of cardiovascular disease in men andwomen with high-normal blood pressure.
Methods
Study Sample
The selection criteria and study design of the Framingham HeartStudy have been described previously.12,13 Subjects in the originalcohort who attended examinations 4 (1956 to 1958, 4541 subjects),12 (1972 to 1974, 3261 subjects), or 18 (1984 to 1986, 1825subjects) and participants in the offspring study who attendedexamination 2 (1978 to 1982, 3863 participants) were eligiblefor this investigation. These examinations are referred to asthe "base-line" examinations. Of the 13,490 attendees, subjectswere excluded if they had hypertension (defined as systolicpressure of at least 140 mm Hg, diastolic pressure of at least90 mm Hg, or use of antihypertensive drugs8,9; 5745 subjects[43 percent] were excluded for that reason) or prevalent cardiovasculardisease (478 subjects [3.5 percent]) at the base-line examinations.Another 408 subjects (3 percent) were excluded because informationon the covariates used in the multivariable analyses detailedbelow was incomplete. After the exclusions, 6859 subjects (3892women and 2967 men) remained eligible for this investigation.Original cohort subjects who were eligible at any examinationremained eligible at the next qualifying examination if theyreached that examination free of cardiovascular disease andhypertension.
Measurement of Blood Pressure and Covariates
At the base-line examination, all participants underwent a physicalexamination with a medical history taking, laboratory assessmentof risk factors for cardiovascular disease, and routine electrocardiography.The average of two readings of systolic and diastolic pressure,measured with a mercury-column sphygmomanometer by a physicianwhile the subject was seated, was recorded as the base-lineblood pressure. At the base-line examination, the subjects wereclassified into one of the three nonhypertensive blood-pressurecategories on the basis of the criteria of JNC VI and WHO-ISH:optimal (systolic pressure of less than 120 mm Hg and diastolicpressure of less than 80 mm Hg), normal (systolic pressure of120 to 129 mm Hg or diastolic pressure of 80 to 84 mm Hg), orhigh-normal (systolic pressure of 130 to 139 mm Hg or diastolicpressure of 85 to 89 mm Hg).8,9 If the systolic and diastolicpressure readings belonged to different categories, the higherof the two readings was used to assign the blood-pressure category.8,9
Follow-up and Outcome Events
All study participants were monitored for cardiovascular eventsand death. Information about cardiovascular events on follow-upwas obtained with the aid of the medical history, physical examinationas part of the Framingham Heart Study (every two years for theoriginal cohort and every four years for the offspring cohort),hospitalization records, and communication with the subjects'personal physicians. All suspected events were reviewed by apanel of three experienced investigators, who evaluated allpertinent medical records. The primary outcome of interest wasthe time to the occurrence of any of the following major cardiovascularevents during 12 years of follow-up: death due to cardiovasculardisease, recognized myocardial infarction, stroke, or congestiveheart failure. These end points were chosen because they havebeen used as major outcome events in clinical trials demonstratingthat treatment of hypertension reduces the risk of cardiovascularevents.14,15,16 The criteria for these end points have beendescribed previously.17 A diagnosis of recognized myocardialinfarction required the presence of at least two of the followingthree criteria: a history of prolonged chest pain, electrocardiographicchanges consistent with myocardial injury, and elevated cardiac-enzymelevels.
Statistical Analysis
Cardiovascular-event rates for each blood-pressure categorywere calculated by dividing the number of subjects who had suchevents by the number of person-years of observation contributedby subjects within a blood-pressure category. The Kaplan–Meierproduct-limit estimator was used to determine the cumulativeincidence of cardiovascular disease in men and women accordingto their blood-pressure category at base line. Sex-specificmultivariable Cox proportional-hazards regression models,18stratified according to the time of the base-line examination(in four categories, corresponding to offspring-cohort examination2 and original-cohort examinations 4, 12, and 18), were constructedto evaluate the association of the base-line blood-pressurecategory with the occurrence of a first cardiovascular eventduring follow-up, after adjustment for age, body-mass index,smoking status, total cholesterol level, and presence or absenceof diabetes mellitus. In addition, trend models were fittedto investigate whether there was an increase in risk from oneblood-pressure category to the next higher category.
To examine whether the association of a given blood-pressurelevel at base line with the risk of future cardiovascular diseasewas mediated by progression to higher levels of blood pressureover time,19 the blood-pressure category and all covariateswere included in Cox models as time-dependent variables duringfollow-up. For this purpose, the subjects were reclassifiedaccording to their blood pressure at each follow-up examination,with the inclusion of hypertension8,9 as an additional category.Cox models incorporating change in blood-pressure category onfollow-up were also examined. Hazard ratios for cardiovasculardisease, with 95 percent confidence intervals, were calculatedfor subjects with normal blood pressure, high-normal blood pressure,and hypertension; persons with optimal blood pressure servedas the reference group.
Additional analyses that included interaction terms (age withblood-pressure category and calendar decade of examination withblood-pressure category) were also performed. The number neededto treat (i.e., the number of patients who would need to havetheir blood pressure lowered) for five years to prevent onemajor cardiovascular event was estimated for subjects with high-normalblood pressure by taking the reciprocal of the absolute reductionin event rates (assuming a range of reductions in event rateswith treatment).20,21 All analyses were performed with SAS software(SAS Institute, Cary, N.C.), primarily Proc Phreg22 on an UltraSparcworkstation (Sun Microsystems, Palo Alto, Calif.). All reportedP values are two-sided, and a P value of less than 0.05 wasconsidered to indicate statistical significance.
Results
Characteristics of the Study Subjects
At base line, a quarter of the study subjects had high-normalblood pressure, a third had normal blood pressure, and the remainderhad optimal blood pressure (Table 1). A higher proportion ofwomen than men in our study sample had optimal blood pressure.Subjects with high-normal blood pressure were older, had a higherbody-mass index, and had higher serum cholesterol levels thanthose with optimal blood pressure.
Table 1. Base-Line Characteristics of the Study Subjects, According to Blood-Pressure Category at Base Line.
Relation of Blood-Pressure Category to the Risk of Cardiovascular Disease
During follow-up (mean, 11.1 years; 75,980 person-years), 397study subjects (138 women and 259 men) had a first cardiovascularevent, including 72 deaths from cardiovascular disease (24 womenand 48 men), 190 recognized myocardial infarctions (35 womenand 155 men), 85 strokes (46 women and 39 men), and 50 casesof congestive heart failure (33 women and 17 men). Cardiovascular-eventrates increased in a stepwise manner across the three blood-pressurecategories (Table 2 and Figure 1). Among younger subjects (35to 64 years old) with high-normal blood pressure, the 10-yearcumulative incidence of cardiovascular disease was 4 percent(95 percent confidence interval, 2 to 5 percent) among womenand 8 percent (95 percent confidence interval, 6 to 10 percent)among men. The 10-year cumulative incidence of cardiovasculardisease was particularly high among older subjects (65 to 90years old) of both sexes with high-normal blood pressure (women:18 percent; 95 percent confidence interval, 12 to 23 percent;men: 25 percent; 95 percent confidence interval, 17 to 34 percent).
Figure 1. Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without Hypertension, According to Blood-Pressure Category at the Base-Line Examination.
Vertical bars indicate 95 percent confidence intervals. Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg. Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg. High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg. If the systolic and diastolic pressure readings for a subject were in different categories, the higher of the two categories was used.
As compared with optimal blood pressure, high-normal blood pressurewas associated with a risk-factor–adjusted hazard ratiofor cardiovascular disease of 2.5 (95 percent confidence interval,1.6 to 4.1) among women and 1.6 (95 percent confidence interval,1.1 to 2.2) among men (Table 3). The hazard ratios associatedwith high-normal blood pressure for the two sexes were not significantlydifferent (P=0.10). Normal blood pressure was associated witha risk-factor–adjusted hazard ratio for cardiovasculardisease of 1.5 (95 percent confidence interval, 0.9 to 2.5)among women and 1.3 (95 percent confidence interval, 1.0 to1.9) among men. In the trend models, a stepwise increase inthe risk of cardiovascular disease was noted with an increasein blood-pressure category (Table 3).
Table 3. Results of Sex-Specific Multivariable Cox Proportional-Hazards Regression Models Examining the Relation of Blood-Pressure Category to the Risk of a First Major Cardiovascular Event.
In analyses in which blood pressure and other risk factors duringfollow-up were modeled as time-dependent variables, the associationof high-normal blood pressure with an increased risk of cardiovasculardisease remained significant for men but was attenuated forwomen (Table 3). An increase in blood-pressure category duringfollow-up was associated with an increased risk of cardiovasculardisease (for men, the hazard ratio associated with an increaseof one category was 1.2 [95 percent confidence interval, 1.1to 1.4], P=0.006; for women, it was 1.4 [95 percent confidenceinterval, 1.1 to 1.6], P=0.002). The subject's age and the timeof the base-line examination had no significant interactionwith high-normal blood pressure (P>0.41 for all analyses).
The crude event rates per 1000 person-years in subjects withhigh-normal blood pressure who were 65 years of age or olderwere 19.5 in women and 28.1 in men. The crude event rates per1000 person-years in subjects with high-normal blood pressurewho were below the age of 65 years were 4.7 in women and 9.2in men. On the basis of these absolute cardiovascular-eventrates in subjects with high-normal blood pressure, and assumingrisk reductions of 10 to 30 percent with blood-pressure lowering,we estimate that for subjects with high-normal blood pressurewho are 65 or older, the numbers needed to treat for five yearsto prevent one cardiovascular event range from 24 to 71 in menand from 34 to 102 in women. The corresponding numbers are considerablyhigher in younger subjects, ranging from 73 to 218 in men andfrom 143 to 429 in women.
Discussion
Although numerous investigators have reported cardiovascularrisks associated with elevated blood pressure,1,2,3,4,5,6,7few have presented the absolute and relative risks of cardiovasculardisease according to the blood-pressure categories used in clinicalpractice. High-normal blood pressure rivals mild hypertensionin prevalence in the U.S. adult population.23 Yet, informationregarding the risk of cardiovascular disease associated withthis blood-pressure category is limited to fatal cardiovascularevents.10,11
Our results extend prior reports in several respects. We determinedabsolute cardiovascular-event rates (in addition to relativerisks) for subjects in the three nonhypertensive blood-pressurecategories. We calculated the incidence of major cardiovascularevents, not just fatal events. We have provided data on thecardiovascular risk associated with high-normal blood pressureseparately for middle-aged and elderly subjects and for menand women. Finally, blood-pressure category and risk factorsduring follow-up were used as time-dependent variables in themultivariable analyses.
Men and women with high-normal blood pressure at base-line examinationhad a higher incidence of cardiovascular disease on follow-upthan those with optimal blood pressure. These relations wereconsistent in both men and women and in both age groups, andthey persisted after adjustment for multiple cardiovascularrisk factors. The rate of cardiovascular events was low amongmen and women with optimal blood pressure, as has been emphasizedby other investigators.24 Furthermore, a continuous gradientof increasing risk across the three nonhypertensive blood-pressurecategories was observed. This finding was further confirmedby tests for trend. In analyses accounting for blood-pressurecategory during follow-up, the association of high-normal bloodpressure with an increased risk of cardiovascular events persistedin men but was attenuated in women.
A 20 percent overall absolute risk of all cardiovascular events(not just major events) at 10 years is considered high and definesthe current threshold for pharmacologic lowering of blood pressurein patients with hypertension, according to some internationalguidelines.9,25,26 In subjects 65 years of age or older in thepresent study, the 10-year absolute rates of major cardiovascularevents associated with high-normal blood pressure exceeded 20percent in men and approached that threshold in women.
If lowering of blood pressure could reduce the five-year absoluterisk of cardiovascular disease by 25 percent in elderly personswith high-normal blood pressure — an assumption basedon the efficacy of blood-pressure lowering in clinical trialsinvolving subjects with hypertension27 — we estimate thatonly 28 men or 41 women would have to have their blood pressurelowered for five years to prevent one major cardiovascular event.These numbers may vary according to the JNC VI risk category.28These estimates are speculative, because there is no evidencethat lowering blood pressure will reduce the risk of cardiovasculardisease in this blood-pressure category. A clinical trial wouldbe needed to determine whether pharmacologic treatment of high-normalblood pressure is beneficial. Our estimates of the number neededto treat could provide a framework for designing such a trial.
Although our results demonstrate that high-normal blood pressureis a marker of an elevated risk of cardiovascular disease, itis uncertain whether the increased risk is attributable solelyto subjects' blood-pressure levels. High-normal blood pressurehas been associated with increased thickness of the carotidintima and media, altered cardiac morphologic features, anddiastolic ventricular dysfunction,29,30,31 which may be precursorsof cardiovascular events. Furthermore, persons in our samplewith high-normal blood pressure frequently had other risk factorsfor cardiovascular disease, as has been reported previously.32The additive effect of more than one risk factor on the riskof cardiovascular disease has been well established.2,11
The prospective study design, the large, community-based sample,and the comprehensive longitudinal surveillance for cardiovascularevents are strengths of the present study. The use of blood-pressurevalues measured on a single occasion is a possible limitation,because it may result in underestimation of the strength ofthe relation between high-normal blood pressure and the incidenceof cardiovascular disease.4,33 Because our study spanned morethan four decades of observation, the absolute event rates reportedmay not be valid for a contemporary cohort. However, when westratified our analyses according to the date of the examinationand tested for an interaction between time period and bloodpressure, we found no interaction, probably because during theperiod of our study, subjects with high-normal blood pressurewere not treated with antihypertensive medication. The factthat our sample was predominantly white limits the generalizabilityof our findings. Moreover, we did not adjust for levels of physicalactivity and high-density lipoprotein cholesterol, because informationregarding these risk factors was not available at the base-lineexaminations.
The recent WHO-ISH report9 emphasized the "rationale for expectinghigh-risk subjects without hypertension to benefit from bloodpressure lowering and the need for clinical trials to investigatethis possibility." Our observational data underscore the needfor additional research to determine whether persons with high-normalblood pressure who are at high risk for cardiovascular disease,such as elderly persons or those with diabetes or multiple riskfactors, will benefit from blood-pressure lowering.
The Framingham Heart Study is supported by a contract (NO1-HC-38038)with the National Heart, Lung, and Blood Institute. Dr. Vasanis the recipient of a research career award (K24 HL 04334-01A1)from the National Heart, Lung, and Blood Institute.
Source Information
From the Framingham Heart Study, Framingham, Mass. (R.S.V., M.G.L., E.P.L., J.C.E., C.J.O., D.L.); the Cardiology Section (R.S.V.) and the Department of Preventive Medicine and Epidemiology (R.S.V., M.G.L., J.C.E., W.B.K., D.L.), Boston University School of Medicine, Boston; the Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (C.J.O.); the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (D.L.); and the National Heart, Lung, and Blood Institute, Bethesda, Md. (C.J.O., D.L.).
Address reprint requests to Dr. Vasan at the Framingham Heart Study, 5 Thurber St., Framingham, MA 01702, or at vasan{at}fram.nhlbi.nih.gov.
References
Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks: US population data. Arch Intern Med 1993;153:598-615. [Free Full Text]
Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996;275:1571-1576. [Free Full Text]
Sagie A, Larson MG, Levy D. The natural history of borderline isolated systolic hypertension. N Engl J Med 1993;329:1912-1917. [Free Full Text]
MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990;335:765-774. [CrossRef][Web of Science][Medline]
Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary artery disease: overall findings and differences by age for 316,099 white men. Arch Intern Med 1992;152:56-64. [Free Full Text]
Eastern Stroke and Coronary Heart Disease Collaborative Research Group. Blood pressure, cholesterol, and stroke in eastern Asia. Lancet 1998;352:1801-1807. [CrossRef][Web of Science][Medline]
van den Hoogen PCW, Feskens EJM, Nagelkerke NJD, Menotti A, Nissinen A, Kromhout D. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. N Engl J Med 2000;342:1-8. [Free Full Text]
The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-2446. [Erratum, Arch Intern Med 1998;158:573.] [Free Full Text]
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999;17:151-183. [Web of Science][Medline]
Neaton JD, Kuller L, Stamler J, Wentworth DN. Impact of systolic and diastolic blood pressure on cardiovascular mortality. In: Laragh JH, Brenner BM, eds. Hypertension: pathophysiology, diagnosis, and management. 2nd ed. New York: Raven Press, 1995:127-44.
Lowe LP, Greenland P, Ruth KJ, Dyer AR, Stamler R, Stamler J. Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med 1998;158:2007-2014. [Free Full Text]
Dawber TR, Meadors GF, Moore FE Jr. Epidemiologic approaches to heart disease: the Framingham Study. Am J Public Health 1951;41:279-286.
Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP. An investigation of coronary heart disease in families: the Framingham Offspring Study. Am J Epidemiol 1979;110:281-290. [Free Full Text]
Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiologic context. Lancet 1990;335:827-838. [CrossRef][Web of Science][Medline]
Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997;277:739-745. [Free Full Text]
Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764. [CrossRef][Web of Science][Medline]
Kannel WB, Wolf PA, Garrison RJ, eds. Some risk factors related to the annual incidence of cardiovascular disease and death in pooled repeated biennial measurements: Framingham Heart Study, 30 year follow-up. Section 34. Bethesda, Md.: Department of Health and Human Services, 1987.
Cox DR, Oakes D. Analysis of survival data. London: Chapman and Hall, 1984.
Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A. High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension 1991;17:22-27. [Free Full Text]
Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988;318:1728-1733. [Web of Science][Medline]
Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452-454. [Erratum, BMJ 1995;310:1056.] [Free Full Text]
SAS/STAT software: changes and enhancements, through release 6.11. Cary, N.C.: SAS Institute, 1996.
Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995;25:305-313. [Free Full Text]
Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;282:2012-2018. [Free Full Text]
Jackson R, Barham P, Bills J, et al. Management of raised blood pressure in New Zealand: a discussion document. BMJ 1993;307:107-110.
Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K. Prevention of coronary heart disease in clinical practice: summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. J Hypertens 1998;16:1407-1414. [CrossRef][Web of Science][Medline]
Gueyffier F, Boutitie F, Boissel JP, et al. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men: a meta-analysis of individual patient data from randomized, controlled trials. Ann Intern Med 1997;126:761-767. [Free Full Text]
Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension 2000;35:539-543. [Free Full Text]
Lonati L, Cuspidi C, Sampieri L, et al. Ultrasonographic evaluation of cardiac and vascular changes in young borderline hypertensives. Cardiology 1993;83:298-303. [Medline]
Escudero E, De Lena S, Graff-Iversen S, Almiron M, Cingolani HE. Left ventricular diastolic function in young men with high normal blood pressure. Can J Cardiol 1996;12:959-964. [Medline]
Kimura Y, Tomiyama H, Nishikawa E, et al. Characteristics of cardiovascular morphology and function in the high-normal subset of hypertension defined by JNC-VI recommendations. Hypertens Res 1999;22:291-295. [Medline]
Lloyd-Jones DM, Evans JC, Larson MG, O'Donnell CJ, Wilson PW, Levy D. Cross-classification of JNC VI blood pressure stages and risk groups in the Framingham Heart Study. Arch Intern Med 1999;159:2206-2212. [Free Full Text]
Clarke R, Shipley M, Lewington S, et al. Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Am J Epidemiol 1999;150:341-353. [Free Full Text]
Britton, K. A., Gaziano, J. M., Djousse, L.
(2009). Normal systolic blood pressure and risk of heart failure in US male physicians. Eur J Heart Fail
11: 1129-1134
[Abstract][Full Text]
Bohm, M., Mahfoud, F., Werner, C., Teo, K., Baumhakel, M.
(2009). Cardiovascular protection: a breakthrough for high-risk patients. Eur Heart J Suppl
11: F19-F26
[Abstract][Full Text]
Ong, H. T.
(2009). Are Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Especially Useful for Cardiovascular Protection?. J Am Board Fam Med
22: 686-697
[Abstract][Full Text]
Leibowitz, A., Grossman, E.
(2009). How to Define Prehypertension in Diabetes/Metabolic Syndrome. Diabetes Care
32: S275-S279
[Full Text]
Grossman, E.
(2009). Should We Treat Prehypertension in Diabetes?: What are the cons?. Diabetes Care
32: S280-S283
[Full Text]
Segura, J., Ruilope, L. M.
(2009). Treatment of Prehypertension in Diabetes and Metabolic Syndrome: What are the pros?. Diabetes Care
32: S284-S289
[Full Text]
De Marco, M., de Simone, G., Roman, M. J., Chinali, M., Lee, E. T., Russell, M., Howard, B. V., Devereux, R. B.
(2009). Cardiovascular and Metabolic Predictors of Progression of Prehypertension Into Hypertension: The Strong Heart Study. Hypertension
54: 974-980
[Abstract][Full Text]
Glasser, S. P., Basile, J. N., Lackland, D. T.
(2009). Does Prehypertension Represent an Increased Risk for Incident Hypertension and Adverse Cardiovascular Outcome?. Hypertension
54: 954-955
[Full Text]
Lucini, D., Zuccotti, G., Malacarne, M., Scaramuzza, A., Riboni, S., Palombo, C., Pagani, M.
(2009). Early Progression of the Autonomic Dysfunction Observed in Pediatric Type 1 Diabetes Mellitus. Hypertension
54: 987-994
[Abstract][Full Text]
Ataei, N., Hosseini, M., Iranmanesh, M.
(2009). The Relationship of Body Mass Index and Blood Pressure in Iranian Children <7 Years Old. J Trop Pediatr
55: 313-317
[Abstract][Full Text]
Mullican, D. R., Lorenzo, C., Haffner, S. M.
(2009). Is Prehypertension a Risk Factor for the Development of Type 2 Diabetes?. Diabetes Care
32: 1870-1872
[Abstract][Full Text]
Cohen, D. L., Bloedon, L. T., Rothman, R. L., Farrar, J. T., Galantino, M. L., Volger, S., Mayor, C., Szapary, P. O., Townsend, R. R.
(2009). Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial. Evid Based Complement Alternat Med
0: nep130v1-nep130
[Abstract][Full Text]
Flint, A. J, Hu, F. B, Glynn, R. J, Jensen, M. K, Franz, M., Sampson, L., Rimm, E. B
(2009). Whole grains and incident hypertension in men. Am. J. Clin. Nutr.
90: 493-498
[Abstract][Full Text]
Pressman, S. D., Matthews, K. A., Cohen, S., Martire, L. M., Scheier, M., Baum, A., Schulz, R.
(2009). Association of Enjoyable Leisure Activities With Psychological and Physical Well-Being. Psychosom. Med.
71: 725-732
[Abstract][Full Text]
Kivimaki, M., Batty, G. D., Singh-Manoux, A., Ferrie, J. E., Tabak, A. G., Jokela, M., Marmot, M. G., Smith, G. D., Shipley, M. J.
(2009). Validating the Framingham Hypertension Risk Score: Results From the Whitehall II Study. Hypertension
54: 496-501
[Abstract][Full Text]
Rubinstein, A., Alcocer, L., Chagas, A.
(2009). High blood pressure in Latin America: a call to action. Ther Adv Cardiovasc Dis
3: 259-285
[Abstract]
Houlihan, S. J., Simpson, S. H., Cave, A. J., Flook, N. W., Hurlburt, M. E., Lord, C. J., Smith, L. L., Sternberg, H. H.
(2009). Hypertension treatment and control rates: Chart review in an academic family medicine clinic. cfp
55: 735-741
[Abstract][Full Text]
Barton, M., Meyer, M. R.
(2009). Postmenopausal Hypertension: Mechanisms and Therapy. Hypertension
54: 11-18
[Full Text]
Plantinga, L. C., Miller, E. R. III, Stevens, L. A., Saran, R., Messer, K., Flowers, N., Geiss, L., Powe, N. R., for the Centers for Disease Control and Prevention,
(2009). Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999-2006. Hypertension
54: 47-56
[Abstract][Full Text]
Su, K.-H., Tsai, J.-Y., Kou, Y. R., Chiang, A.-N., Hsiao, S.-H., Wu, Y.-L., Hou, H.-H., Pan, C.-C., Shyue, S.-K., Lee, T.-S.
(2009). Valsartan regulates the interaction of angiotensin II type 1 receptor and endothelial nitric oxide synthase via Src/PI3K/Akt signalling. Cardiovasc Res
82: 468-475
[Abstract][Full Text]
Mogelvang, R., Sogaard, P., Pedersen, S. A., Olsen, N. T., Schnohr, P., Jensen, J. S.
(2009). Tissue Doppler echocardiography in persons with hypertension, diabetes, or ischaemic heart disease: the Copenhagen City Heart Study. Eur Heart J
30: 731-739
[Abstract][Full Text]
Roghair, R. D., Segar, J. L., Volk, K. A., Chapleau, M. W., Dallas, L. M., Sorenson, A. R., Scholz, T. D., Lamb, F. S.
(2009). Vascular nitric oxide and superoxide anion contribute to sex-specific programmed cardiovascular physiology in mice. Am. J. Physiol. Regul. Integr. Comp. Physiol.
296: R651-R662
[Abstract][Full Text]
Duda, M. K., O'Shea, K. M., Tintinu, A., Xu, W., Khairallah, R. J., Barrows, B. R., Chess, D. J., Azimzadeh, A. M., Harris, W. S., Sharov, V. G., Sabbah, H. N., Stanley, W. C.
(2009). Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc Res
81: 319-327
[Abstract][Full Text]
Ibrahim, H. N., Foley, R., Tan, L., Rogers, T., Bailey, R. F., Guo, H., Gross, C. R., Matas, A. J.
(2009). Long-Term Consequences of Kidney Donation. NEJM
360: 459-469
[Abstract][Full Text]
Trivedi, H., Xiang, Q., Klein, J. P.
(2009). Risk factors for non-fatal myocardial infarction and cardiac death in incident dialysis patients. Nephrol Dial Transplant
24: 258-266
[Abstract][Full Text]
Rosengren, A., Perk, J., Dallongeville, J.
(2009). CHAPTER 12 Prevention of Cardiovascular Disease. ESC Textbook of Cardiovascular Medicine
2: med-9780199566990-chapter-med-9780199566990-chapter
[Abstract][Full Text]
Kannel, W. B., Wolf, P. A.
(2008). Framingham Study Insights on the Hazards of Elevated Blood Pressure. JAMA
300: 2545-2547
[Full Text]
Smoley, B. A., Smith, N. L., Runkle, G. P.
(2008). Hypertension in a Population of Active Duty Service Members. J Am Board Fam Med
21: 504-511
[Abstract][Full Text]
Rohatagi, S., Lee, J., Shenouda, M., Haworth, S., Bathala, M. S., Allison, M., Rubets, I., Heyrman, R., Noveck, R., Salazar, D. E.
(2008). Pharmacokinetics of Amlodipine and Olmesartan After Administration of Amlodipine Besylate and Olmesartan Medoxomil in Separate Dosage Forms and as a Fixed-Dose Combination. J Clin Pharmacol
48: 1309-1322
[Abstract][Full Text]
Godwin, M., Pike, A., Kirby, A., Jewer, C., Murphy, L.
(2008). Prehypertension and hypertension in a primary care practice. cfp
54: 1418-1423
[Abstract][Full Text]
Papanikolaou, Y., Fulgoni, V. L. III
(2008). Bean Consumption Is Associated with Greater Nutrient Intake, Reduced Systolic Blood Pressure, Lower Body Weight, and a Smaller Waist Circumference in Adults: Results from the National Health and Nutrition Examination Survey 1999-2002. J. Am. Coll. Nutr.
27: 569-576
[Abstract][Full Text]
Kokubo, Y., Kamide, K., Okamura, T., Watanabe, M., Higashiyama, A., Kawanishi, K., Okayama, A., Kawano, Y.
(2008). Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease in a Japanese Urban Cohort: The Suita Study. Hypertension
52: 652-659
[Abstract][Full Text]
Romero, J. R., Morris, J., Pikula, A.
(2008). Review: Stroke prevention: modifying risk factors. Ther Adv Cardiovasc Dis
2: 287-303
[Abstract]
Egan, B. M., Nesbitt, S. D., Julius, S.
(2008). Review: Prehypertension: should we be treating with pharmacologic therapy?. Ther Adv Cardiovasc Dis
2: 305-314
[Abstract]
Pletcher, M. J., Bibbins-Domingo, K., Lewis, C. E., Wei, G. S., Sidney, S., Carr, J. J., Vittinghoff, E., McCulloch, C. E., Hulley, S. B.
(2008). Prehypertension during Young Adulthood and Coronary Calcium Later in Life. ANN INTERN MED
149: 91-99
[Abstract][Full Text]
Phillips, L. S., Twombly, J. G.
(2008). It's Time to Overcome Clinical Inertia. ANN INTERN MED
148: 783-785
[Full Text]
Genovesi, S., Pieruzzi, F., Giussani, M., Tono, V., Stella, A., Porta, A., Pagani, M., Lucini, D.
(2008). Analysis of Heart Period and Arterial Pressure Variability in Childhood Hypertension: Key Role of Baroreflex Impairment. Hypertension
51: 1289-1294
[Abstract][Full Text]
Cheng, C., Daskalakis, C., Falkner, B.
(2008). Original Research: Capillary rarefaction in treated and untreated hypertensive subjects. Ther Adv Cardiovasc Dis
2: 79-88
[Abstract]
Wyatt, S. B., Akylbekova, E. L., Wofford, M. R., Coady, S. A., Walker, E. R., Andrew, M. E., Keahey, W. J., Taylor, H. A., Jones, D. W.
(2008). Prevalence, Awareness, Treatment, and Control of Hypertension in the Jackson Heart Study. Hypertension
51: 650-656
[Abstract][Full Text]
Knecht, S., Wersching, H., Lohmann, H., Bruchmann, M., Duning, T., Dziewas, R., Berger, K., Ringelstein, E. B.
(2008). High-Normal Blood Pressure Is Associated With Poor Cognitive Performance. Hypertension
51: 663-668
[Abstract][Full Text]
Sironi, A. M., Pingitore, A., Ghione, S., De Marchi, D., Scattini, B., Positano, V., Muscelli, E., Ciociaro, D., Lombardi, M., Ferrannini, E., Gastaldelli, A.
(2008). Early Hypertension Is Associated With Reduced Regional Cardiac Function, Insulin Resistance, Epicardial, and Visceral Fat. Hypertension
51: 282-288
[Abstract][Full Text]
Geller, J. C., Cassens, S., Brosz, M., Keil, U., Bernarding, J., Kropf, S., Bierwirth, R. A., Lippmann-Grob, B., Schultheiss, H.-P., Schluter, K., Pels, K.
(2007). Achievement of guideline-defined treatment goals in primary care: the German Coronary Risk Management (CoRiMa) study. Eur Heart J
28: 3051-3058
[Abstract][Full Text]
Player, M. S., King, D. E., Mainous, A. G. III, Geesey, M. E.
(2007). Psychosocial Factors and Progression From Prehypertension to Hypertension or Coronary Heart Disease. Ann Fam Med
5: 403-411
[Abstract][Full Text]
Conen, D., Ridker, P. M, Buring, J. E, Glynn, R. J
(2007). Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: prospective cohort study. BMJ
335: 432-432
[Abstract][Full Text]
Chobanian, A. V.
(2007). Isolated Systolic Hypertension in the Elderly. NEJM
357: 789-796
[Full Text]
Collins, P., Rosano, G., Casey, C., Daly, C., Gambacciani, M., Hadji, P., Kaaja, R., Mikkola, T., Palacios, S., Preston, R., Simon, T., Stevenson, J., Stramba-Badiale, M.
(2007). Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists. Eur Heart J
28: 2028-2040
[Abstract][Full Text]
Taylor, E. N., Forman, J. P., Farwell, W. R.
(2007). Serum Anion Gap and Blood Pressure in the National Health and Nutrition Examination Survey. Hypertension
50: 320-324
[Abstract][Full Text]
Ninomiya, T., Kubo, M., Doi, Y., Yonemoto, K., Tanizaki, Y., Tsuruya, K., Sueishi, K., Tsuneyoshi, M., Iida, M., Kiyohara, Y.
(2007). Prehypertension Increases the Risk for Renal Arteriosclerosis in Autopsies: The Hisayama Study. J. Am. Soc. Nephrol.
18: 2135-2142
[Abstract][Full Text]
Authors/Task Force Members:, , Mancia, G., De Backer, G., Dominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., Narkiewicz, K., Ruilope, L., Rynkiewicz, A., Schmieder, R. E., Struijker Boudier, H. A.J., Zanchetti, A., ESC Committee for Practice Guidelines (CPG):, , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., ESH Scientific Council:, , Kjeldsen, S. E., Erdine, S., Narkiewicz, K., Kiowski, W., Agabiti-Rosei, E., Ambrosioni, E., Cifkova, R., Dominiczak, A., Fagard, R., Heagerty, A. M., Laurent, S., Lindholm, L. H., Mancia, G., Manolis, A., Nilsson, P. M., Redon, J., Schmieder, R. E., Struijker-Boudier, H. A.J., Viigimaa, M., Document Reviewers:, , Filippatos, G., Adamopoulos, S., Agabiti-Rosei, E., Ambrosioni, E., Bertomeu, V., Clement, D., Erdine, S., Farsang, C., Gaita, D., Kiowski, W., Lip, G., Mallion, J.-M., Manolis, A. J., Nilsson, P. M., O'Brien, E., Ponikowski, P., Redon, J., Ruschitzka, F., Tamargo, J., van Zwieten, P., Viigimaa, M., Waeber, B., Williams, B., Zamorano, J. L.
(2007). 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J
0: ehm236v1-75
[Full Text]
Wexler, R. K.
(2007). Treatment of Hypertension Critical in Reducing Morbidity and Mortality. J Am Board Fam Med
20: 322-322
[Full Text]
Cook, N. R, Cutler, J. A, Obarzanek, E., Buring, J. E, Rexrode, K. M, Kumanyika, S. K, Appel, L. J, Whelton, P. K
(2007). Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ
334: 885-885
[Abstract][Full Text]
Kikuya, M., Hansen, T. W., Thijs, L., Bjorklund-Bodegard, K., Kuznetsova, T., Ohkubo, T., Richart, T., Torp-Pedersen, C., Lind, L., Ibsen, H., Imai, Y., Staessen, J. A., on behalf of the International Database on Ambulat,
(2007). Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk. Circulation
115: 2145-2152
[Abstract][Full Text]
Redon, J., Cea-Calvo, L., Lozano, J. V., Marti-Canales, J. C., Llisterri, J. L., Aznar, J., Gonzalez-Esteban, J., on behalf of the investigators of the PREV-ICTUS s,
(2007). Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain: The PREV-ICTUS Study. Stroke
38: 1167-1173
[Abstract][Full Text]
Deepak, D, Furlong, N J, Wilding, J P H, MacFarlane, I A
(2007). Cardiovascular disease, hypertension, dyslipidaemia and obesity in patients with hypothalamic-pituitary disease. Postgrad. Med. J.
83: 277-280
[Abstract][Full Text]
Nawrot, T. S., Staessen, J. A., Roels, H. A., Den Hond, E., Thijs, L., Fagard, R. H., Dominiczak, A. F., Struijker-Boudier, H. A.
(2007). Blood pressure and blood selenium: a cross-sectional and longitudinal population study. Eur Heart J
28: 628-633
[Abstract][Full Text]
Hsia, J., Margolis, K. L., Eaton, C. B., Wenger, N. K., Allison, M., Wu, L., LaCroix, A. Z., Black, H. R., for the Women's Health Initiative Investigators,
(2007). Prehypertension and Cardiovascular Disease Risk in the Women's Health Initiative. Circulation
115: 855-860
[Abstract][Full Text]
Erdogan, D., Yildirim, I., Ciftci, O., Ozer, I., Caliskan, M., Gullu, H., Muderrisoglu, H.
(2007). Effects of Normal Blood Pressure, Prehypertension, and Hypertension on Coronary Microvascular Function. Circulation
115: 593-599
[Abstract][Full Text]
Opie, L. H.
(2007). Metabolic Syndrome. Circulation
115: e32-e35
[Full Text]
Drukteinis, J. S., Roman, M. J., Fabsitz, R. R., Lee, E. T., Best, L. G., Russell, M., Devereux, R. B.
(2007). Cardiac and Systemic Hemodynamic Characteristics of Hypertension and Prehypertension in Adolescents and Young Adults: The Strong Heart Study. Circulation
115: 221-227
[Abstract][Full Text]
Weir, M. R.
(2007). How Do You Define "Hypertension" in a Patient With Type 1 Diabetes?. Hypertension
49: 13-14
[Full Text]
Kistler, P. M., Sanders, P., Dodic, M., Spence, S. J., Samuel, C. S., Zhao, C., Charles, J. A., Edwards, G. A., Kalman, J. M.
(2006). Atrial electrical and structural abnormalities in an ovine model of chronic blood pressure elevation after prenatal corticosteroid exposure: implications for development of atrial fibrillation. Eur Heart J
27: 3045-3056
[Abstract][Full Text]
Okere, I. C., Young, M. E., McElfresh, T. A., Chess, D. J., Sharov, V. G., Sabbah, H. N., Hoit, B. D., Ernsberger, P., Chandler, M. P., Stanley, W. C.
(2006). Low Carbohydrate/High-Fat Diet Attenuates Cardiac Hypertrophy, Remodeling, and Altered Gene Expression in Hypertension. Hypertension
48: 1116-1123
[Abstract][Full Text]
Chobanian, A. V.
(2006). Prehypertension Revisited. Hypertension
48: 812-814
[Full Text]
Ingelsson, E, Arnlov, J, Lind, L, Sundstrom, J
(2006). Metabolic syndrome and risk for heart failure in middle-aged men. Heart
92: 1409-1413
[Abstract][Full Text]
Grotto, I., Grossman, E., Huerta, M., Sharabi, Y.
(2006). Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles Among Young Israeli Adults. Hypertension
48: 254-259
[Abstract][Full Text]
White, W. B., Hanes, V., Chauhan, V., Pitt, B.
(2006). Effects of a New Hormone Therapy, Drospirenone and 17-{beta}-Estradiol, in Postmenopausal Women With Hypertension. Hypertension
48: 246-253
[Abstract][Full Text]
Stang, A., Moebus, S., Mohlenkamp, S., Dragano, N., Schmermund, A., Beck, E.-M., Siegrist, J., Erbel, R., Jockel, K.-H., on behalf of the Heinz Nixdorf Recall Study Invest,
(2006). Algorithms for Converting Random-Zero to Automated Oscillometric Blood Pressure Values, and Vice Versa. Am J Epidemiol
164: 85-94
[Abstract][Full Text]
Ommen, E. S., Winston, J. A., Murphy, B.
(2006). Medical Risks in Living Kidney Donors: Absence of Proof Is Not Proof of Absence. CJASN
1: 885-895
[Abstract][Full Text]
Srinivasan, S. R., Myers, L., Berenson, G. S.
(2006). Changes in Metabolic Syndrome Variables Since Childhood in Prehypertensive and Hypertensive Subjects: The Bogalusa Heart Study. Hypertension
48: 33-39
[Abstract][Full Text]
Zillich, A. J., Haines, S. T.
(2006). ASHP Therapeutic Position Statement on the Treatment of Hypertension.. Am J Health Syst Pharm
63: 1074-1080
[Full Text]
Poulter, N.
(2006). Are current therapies for hypertension achieving their goal?. Journal of Renin-Angiotensin-Aldosterone System
7: S3-S6
[Abstract]
Pearte, C. A., Furberg, C. D., O'Meara, E. S., Psaty, B. M., Kuller, L., Powe, N. R., Manolio, T.
(2006). Characteristics and Baseline Clinical Predictors of Future Fatal Versus Nonfatal Coronary Heart Disease Events in Older Adults: The Cardiovascular Health Study. Circulation
113: 2177-2185
[Abstract][Full Text]
Kovesdy, C. P., Trivedi, B. K., Kalantar-Zadeh, K., Anderson, J. E.
(2006). Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease. Nephrol Dial Transplant
21: 1257-1262
[Abstract][Full Text]
Lee, J. E., Kim, Y.-G., Choi, Y.-H., Huh, W., Kim, D. J., Oh, H. Y.
(2006). Serum Uric Acid Is Associated With Microalbuminuria in Prehypertension. Hypertension
47: 962-967
[Abstract][Full Text]
Schunkert, H.
(2006). Pharmacotherapy for Prehypertension -- Mission Accomplished?. NEJM
354: 1742-1744
[Full Text]
Julius, S., Nesbitt, S. D., Egan, B. M., Weber, M. A., Michelson, E. L., Kaciroti, N., Black, H. R., Grimm, R. H. Jr., Messerli, F. H., Oparil, S., Schork, M. A., the Trial of Preventing Hypertension (TROPHY) Stud,
(2006). Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker. NEJM
354: 1685-1697
[Abstract][Full Text]
Elmer, P. J., Obarzanek, E., Vollmer, W. M., Simons-Morton, D., Stevens, V. J., Young, D. R., Lin, P.-H., Champagne, C., Harsha, D. W., Svetkey, L. P., Ard, J., Brantley, P. J., Proschan, M. A., Erlinger, T. P., Appel, L. J., for the PREMIER Collaborative Research Group,
(2006). Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial. ANN INTERN MED
144: 485-495
[Abstract][Full Text]
Wang, W., Lee, E. T., Fabsitz, R. R., Devereux, R., Best, L., Welty, T. K., Howard, B. V.
(2006). A Longitudinal Study of Hypertension Risk Factors and Their Relation to Cardiovascular Disease: The Strong Heart Study. Hypertension
47: 403-409
[Abstract][Full Text]
Appel, L. J., Brands, M. W., Daniels, S. R., Karanja, N., Elmer, P. J., Sacks, F. M.
(2006). Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association. Hypertension
47: 296-308
[Abstract][Full Text]
Tomiyama, H., Hashimoto, H., Hirayama, Y., Yambe, M., Yamada, J., Koji, Y., Shiina, K., Yamamoto, Y., Yamashina, A.
(2006). Synergistic Acceleration of Arterial Stiffening in the Presence of Raised Blood Pressure and Raised Plasma Glucose. Hypertension
47: 180-188
[Abstract][Full Text]
Barlow, C. E., LaMonte, M. J., FitzGerald, S. J., Kampert, J. B., Perrin, J. L., Blair, S. N.
(2006). Cardiorespiratory Fitness Is an Independent Predictor of Hypertension Incidence among Initially Normotensive Healthy Women. Am J Epidemiol
163: 142-150
[Abstract][Full Text]
Prepared by: British Cardiac Society, British Hype,
(2005). JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart
91: v1-v52
[Full Text]
Lucini, D., Di Fede, G., Parati, G., Pagani, M.
(2005). Impact of Chronic Psychosocial Stress on Autonomic Cardiovascular Regulation in Otherwise Healthy Subjects. Hypertension
46: 1201-1206
[Abstract][Full Text]
Asayama, K., Ohkubo, T., Kikuya, M., Metoki, H., Obara, T., Hoshi, H., Hashimoto, J., Totsune, K., Satoh, H., Imai, Y.
(2005). Use of 2003 European Society of Hypertension-European Society of Cardiology guidelines for predicting stroke using self-measured blood pressure at home: the Ohasama study. Eur Heart J
26: 2026-2031
[Abstract][Full Text]
Lloyd-Jones, D. M., Sutton-Tyrrell, K., Patel, A. S., Matthews, K. A., Pasternak, R. C., Everson-Rose, S. A., Scuteri, A., Chae, C. U.
(2005). Ethnic Variation in Hypertension Among Premenopausal and Perimenopausal Women: Study of Women's Health Across the Nation. Hypertension
46: 689-695
[Abstract][Full Text]
Abuissa, H., Jones, P. G., Marso, S. P., O'Keefe, J. H. Jr
(2005). Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers for Prevention of Type 2 Diabetes: A Meta-Analysis of Randomized Clinical Trials. J Am Coll Cardiol
46: 821-826
[Abstract][Full Text]
