Fifty years of Framingham Study contributions to understanding hypertension

The Framingham Study established hypertension as a major cardiovascular ris k factor and quantified its atherogenic cardiovascular disease potential. A n historical perspective is presented on the epidemiological insights about hypertension derived from 50 years of Framingham Study research into the p revalence, incidence, determinants and hazards of hypertension. Existing mi sconceptions about the presence of critical levels of blood pressure, the i mpact of the systolic and diastolic components of blood pressure, the hazar d 'mild' hypertension, the impact in advanced age and the hazard of left ve ntricular hypertrophy. The importance of isolated systolic hypertension and the pulse pressure were demonstrated. It has been demonstrated that hypert ension seldom occurs in isolation of other atherogenic risk factors, with w hich it tends to cluster. This clustering with other metabolically linked r isk factors has been shown to reflect insulin resistance promoted by weight gain and abdominal obesity. Obesity was shown to be one of the major deter minants of hypertension in the general population. Left ventricular hypertr ophy was shown to be an ominous harbinger of cardiovascular disease rather than an incidental compensatory phenomenon. Multivariate risk profiles for coronary disease, stroke, peripheral artery disease and heart failure have been devised to facilitate incorporation of elevated blood pressure in a gl obal, multivariate cardiovascular risk assessment.