The DOI matches its Crossref record; 46 of the 46 references it cites were found in a registry or an index.
The Progression From Hypertension to Congestive Heart Failure
Abstract
OBJECTIVES: - To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects. DESIGN: - Inception cohort study. SETTING: - General community. PARTICIPANTS: - Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970. EXPOSURE MEASURES: - Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations. OUTCOME MEASURE: - The development of CHF. RESULTS: - A total of 5143 eligible subjects contributed 72422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years. CONCLUSIONS: - Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.
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In the citing paper
“up to 91% of all new heart failure development in the Framingham cohort occurred in people with a previous diagnosis of hypertension (275).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [275]
In the citing paper
“The vast majority of incident heart failure is preceded by hypertension;”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [275]
In the citing paper
“The vast majority of incident heart failure is preceded by hypertension; up to 91% of all new heart failure development in the Framingham cohort occurred in people with a previous diagnosis of hypertension (272).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [272]
In the citing paper
“Using 50 years of follow up data, Levy and colleagues reported that the 5 year mortality declined in men from 70% in 1950 to 59% in 1999, and in women from 57% to 45%.58”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [58]
In the citing paper
“Using 50 years of follow up data, Levy and colleagues reported that the 5 year mortality declined in men from 70% in 1950 to 59% in 1999, and in women from 57% to 45%.58”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [58]
In the citing paper
“Over 50% of heart disease, stroke, and heart failure are caused by increased blood pressure.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [8]
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Sleep heart rate variability assists the automatic prediction of long-term cardiovascular outcomes
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“Although gender is a potential risk in coronary heart disease [58,66] and myocardial infarction [67], also medical history of diabetes [68,69] or hypertension [70,71] is associated with a high risk of CVD outcomes, those features contributed little to the prediction of CVD outcomes in the present study.”
BackgroundEpidemiology, Pathophysiology, and Prognosis of Heart Failure in the Elderly
Thomas, S., & Rich, M. W. (2007) · Heart Failure Clinics · doi:10.1016/j.hfc.2007.07.004 · Cited by 77
Renal sympathetic denervation: applications in hypertension and beyond
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“Hypertension is not only one of the most serious risk factors for deaths and disease worldwide [14], but is also a major contributor to chronic heart failure, and a major risk factor for stroke and coronary heart disease, and their progression [15].”
BackgroundRigaud, A., & Forette, B. (2001) · The Journals of Gerontology Series A · doi:10.1093/gerona/56.4.m217 · Cited by 76
“In a report of the Framingham cohort who developed heart failure, these elderly people tended to have primarily systolic hypertension (38).”
BackgroundTreatment of hypertension in patients with coronary artery disease
Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., Cannon, C. P., de Lemos, J. A., Elliott, W. J., Findeiss, L., et al. (2015) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2015.03.002 · Cited by 79
“Early investigations of patients with HF such as the Framingham Heart Study cited hypertension as the most frequent comorbidity; hypertension accounted for 39% of HF cases in men and 59% in women.(217) In a population-based study in Olmstead County, Minnesota, ≈50% of patients presenting with new-onset HF had hyperten…”
BackgroundSelf-citationDiabetes and the Risk of Heart Failure
Dhingra, R., & Vasan, R. S. (2011) · Heart Failure Clinics · doi:10.1016/j.hfc.2011.08.008 · Cited by 78
Holland, D. J., Prasad, S. B., & Marwick, T. H. (2010) · Heart · doi:10.1136/hrt.2009.183947 · Cited by 75
Zhou, W., Brown, J. M., Bajaj, N. S., Chandra, A., Divakaran, S., Weber, B., Bibbo, C. F., Hainer, J. M., Taqueti, V. R., Dorbala, S., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa191 · Cited by 75
“Beyond associations with stroke and atherosclerosis, hypertension is the most common risk factor for heart failure (HF).(1,2) Importantly, once hypertensive HF develops, survival is 24–31% at 5 years,(2) highlighting the need for early identification and treatment of patients at risk.”
BackgroundSex and gender differences in myocardial hypertrophy and heart failure
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Hypertension as a Risk Factor for Heart Failure
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An Epidemiologic Perspective of Systemic Hypertension, Ischemic Heart Disease, and Heart Failure
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Soufi Taleb Bendiab, N., Meziane-Tani, A., Ouabdesselam, S., Methia, N., Latreche, S., Henaoui, L., Monsuez, J.-J., & Benkhedda, S. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317721644 · Cited by 74
Role of the lysyl oxidase enzyme family in cardiac function and disease
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“ystemic arterial hypertension (HTN) is one of the most common risk factors for the development of atrial fibrillation (AF) (1).”
BackgroundUltrastructural remodelling of Ca2+ signalling apparatus in failing heart cells
Wu, H., Xu, M., Li, R.-C., Guo, L., Lai, Y., Xu, S.-M., Li, S., Lü, Q., Li, L., Zhang, H., et al. (2012) · Cardiovascular Research · doi:10.1093/cvr/cvs195 · Cited by 74
“cardiac death is the progressive decrease in myocardial contractility.(8) –12 In failing heart cells, the degraded contractility is at least”
BackgroundIyer, A., Ahmed, M., Filippatos, G., Ekundayo, O. J., Aban, I. B., Love, T., Nanda, N., Bakris, G., Fonarow, G., Aronow, W., et al. (2010) · Journal of the American Society of Hypertension : JASH · doi:10.1016/j.jash.2010.02.002 · Cited by 75
“It is possible that more matched patients with uncontrolled hypertension developed LVH during follow-up.(30,31) Because the prevalence of LVH was low (n 1⁄4 84) in our study, the attributable risk of LVH is likely also to be low.”
InfluentialSão Paulo call to action for the prevention and control of high blood pressure: 2020
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Renal-Cardiac Crosstalk in the Pathogenesis and Progression of Heart Failure
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Cardiovascular and noncardiovascular comorbidities in patients with chronic heart failure
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Cost-effectiveness of the Lower Treatment Goal (of JNC VI) for Diabetic Hypertensive Patients
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“Incidence rates for heart failure were also based on Framingham data, combining normotensive and “mild” hypertensive rates, and adjusting for the relative increase in risk due to diabetes.(12,22) The incidence of ESRD depends more on the duration of diabetes, rather than age.”
MethodMyocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis.
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Cardiovascular changes during chronic hypertensive states
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“body composition, hormone or reproductive factors, endothelial inflammation, and microvascular function (40) or to the presence of diabetes and hypertension (potent risk factors forheart failure inwomen) (41).”
BackgroundRisk Factors for Heart Failure in the Community: Differences by Age and Ejection Fraction
Chamberlain, A. M., Boyd, C. M., Manemann, S. M., Dunlay, S. M., Gerber, Y., Killian, J. M., Weston, S. A., & Roger, V. L. (2019) · The American Journal of Medicine · doi:10.1016/j.amjmed.2019.10.030 · Cited by 72
Lieberman, D. E., Kistner, T. M., Richard, D. J., Lee, I.-M. M., & Baggish, A. L. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2107621118 · Cited by 82
Heart Failure in Women – Insights from the Framingham Heart Study
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“In prior analyses adjusted for angina pectoris, diabetes mellitus, ECGLVH, and valvular heart disease, presence of myocardial infarction conferred a 6-fold increase in the risk of HF (Table 2) [13].”
InfluentialFHL2 Binds Calcineurin and Represses Pathological Cardiac Growth
Hojayev, B., Rothermel, B. A., Gillette, T. G., & Hill, J. A. (2012) · Molecular and Cellular Biology · doi:10.1128/mcb.05948-11 · Cited by 72
“Epidemiological evidence links left ventricular (LV) hypertrophy with adverse cardiovascular events, including heart failure and death (1, 13, 35, 36).”
BackgroundBuys, E. S., Raher, M. J., Blake, S. L., Neilan, T. G., Graveline, A. R., Passeri, J. J., Llano, M., Pérez-Sanz, T. M., Ichinose, F., Janssens, S. P., et al. (2007) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.01236.2006 · Cited by 72
“Chronic left ventricular (LV) pressure overload, such as that due to systemic hypertension, is a major contributor to congestive heart failure (16).”
BackgroundThe use of collagen-derived serum peptides for the clinical assessment of hypertensive heart disease
López, B., González, A., Querejeta, R., & Dı́ez, J. (2005) · Journal of Hypertension · doi:10.1097/01.hjh.0000173780.67308.f1 · Cited by 72
Normal Systolic Blood Pressure and Risk of Heart Failure in US Male Physicians
Britton, K. A., Gaziano, J. M., & Djoussé, L. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp141 · Cited by 73
“However, not all patients with elevated blood pressure who develop HF have LVH. Studies have demonstrated that increased vascular stiffness and resistance can lead to abnormal left ventricular wall stress even in the absence of left ventricular hypertrophy.17,18 These abnormalities in myocardial compliance may be impo…”
BackgroundInfluential
Metadata
- Authors
- Levy, D.
- Affiliations
- Framingham Heart Study (US)
- Corresponding author
- Levy, Daniel
- ORCID
- Levy, Daniel
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1996-05-22
- Volume
- 275
- Issue
- 20
- Pages
- 1557
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2023515446
- Cited by
- 2,155
- References
- 46
- Citations by year
- 2026: 32 · 2025: 62 · 2024: 62 · 2023: 85 · 2022: 82 · 2021: 73 · 2020: 71 · 2019: 86 · 2018: 70 · 2017: 75 · 2016: 68 · 2015: 98 · 2014: 86 · 2013: 102 · 2012: 108
- FWCI
- 27.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc038038-022)
- National Heart, Lung, and Blood Institute (N01-HC-38038)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- hypertension, congestive heart failure, population attributable risk, heart failure risk factors, myocardial infarction, diabetes mellitus, left ventricular hypertrophy, valvular heart disease, blood pressure control, Framingham Heart Study, Framingham Offspring Study
- MeSH terms
- Adult, Aged, Diastole, Female, Heart Failure, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Risk Factors, Systole, Cohort Studies, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, Hypertrophy, Left Ventricular, Disease Progression, Ventricular Dysfunction, Left
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