Nisha I. Parikh, MD, MPH; Michael J. Pencina, PhD; Thomas J. Wang, MD; Emelia J. Benjamin, MD, ScM; Katherine J. Lanier, BS; Daniel Levy, MD; Ralph B. D'Agostino, PhD; William B. Kannel, MD; Ramachandran S. Vasan, MD
Grant Support: By National Heart, Lung, and Blood Institute contracts N01-HC-25195 and K23-HL074077-01 (Dr. Wang) and 2K24HL04334 (Dr. Vasan).
Potential Financial Conflicts of Interest:Other: T.J. Wang (Novartis Institutes for Biomedical Research).
Requests for Single Reprints: Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803; e-mail, email@example.com.
Current Author Addresses: Dr. Parikh: Cardiovascular Division, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, West Baker 4, Boston, MA 02215.
Drs. Pencina and D'Agostino and Ms. Lanier: Department of Mathematics and Statistics, Department of Biostatistics, Boston University, 111 Cummington Street, Boston, MA 02215.
Dr. Wang: Cardiology Division, GRB-800, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Drs. Benjamin, Levy, Kannel, and Vasan: Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803.
Author Contributions: Conception and design: N.I. Parikh, M.J. Pencina, T.J. Wang, R.B. D'Agostino Sr., R.S. Vasan.
Analysis and interpretation of the data: N.I. Parikh, M.J. Pencina, K.J. Lanier, D. Levy, R.B. D'Agostino Sr., R.S. Vasan.
Drafting of the article: N.I. Parikh, M.J. Pencina, R.S. Vasan.
Critical revision of the article for important intellectual content: N.I. Parikh, M.J. Pencina, T.J. Wang, E.J. Benjamin, D. Levy, R.B. D'Agostino Sr., W.B. Kannel, R.S. Vasan.
Final approval of the article: N.I. Parikh, M.J. Pencina, T.J. Wang, E.J. Benjamin, R.B. D'Agostino Sr., W.B. Kannel, R.S. Vasan.
Statistical expertise: M.J. Pencina, R.B. D'Agostino Sr.,
Obtaining of funding: R.B. D'Agostino Sr., R.S. Vasan.
Administrative, technical or logistic support: R.S. Vasan.
Collection and assembly of data: N.I. Parikh, K.J. Lanier, D. Levy.
Parikh N., Pencina M., Wang T., Benjamin E., Lanier K., Levy D., D'Agostino R., Kannel W., Vasan R.; A Risk Score for Predicting Near-Term Incidence of Hypertension: The Framingham Heart Study. Ann Intern Med. 2008;148:102-110. doi: 10.7326/0003-4819-148-2-200801150-00005
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Published: Ann Intern Med. 2008;148(2):102-110.
In 2003, the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure created a prehypertension category for persons with blood pressures ranging from 120 to 139 mm Hg (systolic) or from 80 to 89 mm Hg (diastolic). The committee strongly advocated lifestyle and behavioral modification for individuals with prehypertension (1). This new recommendation was based largely on epidemiologic evidence that individuals with nonoptimal blood pressure (>120/80 mm Hg) are at increased risk for progression to overt hypertension (1, 2) and that cardiovascular disease risk increases in a graded fashion beginning at a blood pressure of 115/75 mm Hg, well within the “normal” range (1, 3). However, this new categorization scheme resulted in 70 million people being considered prehypertensive, a situation that poses a challenge for both physicians and patients.
Institute of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
January 24, 2008
Relation between anxiety and the hypertension risk
Parikh NI et al do develop a simple risk prediction algorithm that estimates an individual's 1-, 2- and 4-year probability of developing hypertension. They examine the following candidate risk factors: age, sex, body weight, body mass index, physical activity index, systolic blood pressure, diastolic blood pressure, moderate alcohol intake, parental hypertension and cigarette smoking . And their risk score does not take into account some predictors of hypertension that may not be routinely measured, such as nonsteroidal anti-inflammatory drugs, salt intake, vegetable, fat intake, or exercise. However, one important clinical predictor of hypertension, anxiety, is not involved in their investigation.
Anxiety is known to be closely associated with incident hypertension, and may be the precursor to hypertension [2,3]. The higher rate of hypertension incidence is found closely accompanied with anxiety for Chinese patients . In general, the more nervous Chinese hospital patients fell, the higher blood pressure they get. Anxiety can easily be measured in a physician's office in primary care settings. For example, at each Framingham Heart Study examination, the investigators may record and evaluate the following factors of anxiety: the daily intensity (with a score range from 0 to 5; 0 being the minimum; 5 being the maximum level), duration (hours per month), and frequency (days per month). Parikh NI and colleagues do not provide any information regarding the relation of anxiety with the hypertension risk. The readers will be very interested to know whether anxiety is one significant predictor of hypertension for nonhypertensive white individuals.
1 Parikh NI, Pencina MJ, Wang TJ, Benjamin EJ, Lanier KJ, Levy D, et al. A risk score for predicting near-term incidence of hypertension: the Framingham Heart Study. Ann Intern Med. 2008; 148(2): 102-10.
2 Spruill TM, Pickering TG, Schwartz JE, Mostofsky E, Ogedegbe G, Clemow L, et al. The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med. 2007; 34(1): 1-9.
3 Dimsdale JE. Symptoms of anxiety and depression as precursors to hypertension. JAMA. 1997; 277(7): 574-5.
4 Wei TM, Wang L. Anxiety symptoms in patients with hypertension: a community-based study. Int J Psychiatry Med. 2006; 36(3): 315-22.
March 31, 2008
Dear Dr. Nisha,
I was very impressed by a risk factor calculator for predicting hypertension. Could this calculator be used in the clinical follow-up of the pre-hypertense patient? I supposse there is an option for on-line calculation, althoung I havenÂ´t seen any link in the paper. Thank-you very much and congratulations for this valuable item.
Francisco SÃ¡nchez Barcelona Spain
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Cardiology, Nephrology, Hypertension, Coronary Risk Factors.
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