Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study

JAMA. 2002 Feb 27;287(8):1003-10. doi: 10.1001/jama.287.8.1003.


Context: The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown.

Objectives: To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk.

Design, setting, and participants: Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998).

Main outcome measures: Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications.

Results: The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (greater-than-or-equal to 140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (greater-than-or-equal to 160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure.

Conclusion: The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antihypertensive Agents
  • Blood Pressure
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Probability
  • Prospective Studies
  • Risk
  • United States / epidemiology


  • Antihypertensive Agents