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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“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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“Body weight was significantly increased in OVX rats compared to their respective NS and HS cohorts (Estrogen: F(1,21)1⁄4 38.”
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“Cardiac hypertrophy is the physiological response to pressure overload but becomes pathological when it exceeds normal limits, resulting in loss of contractile performance and ultimately in heart failure([7]).”
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MethodHeart Failure and its Treatment in Women
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“However, a documented history of ischemic heart disease was present in 67% and of hypertension in 31% (see Table 1), indicating that these were the two most common aetiologies for heart failure, which is in good agreement with other findings [20,21].”
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“29”
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“It plays a major etiological role in the development of HF and ischaemic heart disease, with even modest increases in blood pressure contributing to the long term risk [9,22].”
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P‐Wave Indices, Distribution and Quality Control Assessment (from the Framingham Heart Study)
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P‐Wave Indices: Derivation of Reference Values from the Framingham Heart Study
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“0) Systolic blood pressure, mmHg 119 (11) 121 (11) 117 (11) Diastolic blood pressure, mmHg 74 (8) 75 (8) 74 (8) Total/high-density lipoprotein cholesterol ratio 4.”
Dong, F., Takawale, A. R., Shen, M., Samokhvalov, V., Basu, R., Patel, V. B., Wang, X., Fernández-Patrón, C., Seubert, J. M., Oudit, G. Y., et al. (2016) · Hypertension · doi:10.1161/hypertensionaha.116.07566 · Cited by 44
“Hypertension is by far the most common antecedent condition in patients with heart failure and drives adverse myocardial remodeling and pathological hypertrophy.(2,35) In this study, we report a unique function for ADAM17 in regulating myocardial hypertrophy in response to mechanical stress by proteolytic cleavage of…”
BackgroundKoentges, C., Pepin, M. E., Muesse, C., Pfeil, K., Alvarez, S. V. V., Hoppe, N., Hoffmann, M. M., Odening, K. E., Sossalla, S. T., Zirlik, A., et al. (2017) · Basic Research in Cardiology · doi:10.1007/s00395-017-0666-6 · Cited by 44
“cardiac-related morbidity and mortality [18, 36].”
BackgroundKim, K., Ihm, S., Kim, G., Kim, H. C., Kim, J. H., Lee, H., Lee, J. H., Park, J. M., Park, S., Pyun, W. B., et al. (2019) · Clinical Hypertension · doi:10.1186/s40885-019-0123-y · Cited by 45
Díaz-Cañestro, C., & Montero, D. (2020) · Sports Medicine · doi:10.1007/s40279-020-01294-9 · Cited by 44
Race- and Sex-Specific Population Attributable Fractions of Incident Heart Failure
Sinha, A., Ning, H., Carnethon, M. R., Allen, N. B., Wilkins, J. T., Lloyd‐Jones, D. M., & Khan, S. S. (2021) · Circulation Heart Failure · doi:10.1161/circheartfailure.120.008113 · Cited by 43
Effects of exercise and cardiac rehabilitation on cardiovascular outcomes
Ades, P. A., Green, N. M., & Coello, C. E. (2003) · Cardiology Clinics · doi:10.1016/s0733-8651(03)00056-0 · Cited by 44
“Hypertension is a well-established risk factor for the development and progression of coronary artery disease, cerebrovascular disease, renovascular disease, and chronic heart failure [75].”
BackgroundSocioeconomic Factors as Predictors of Incident Heart Failure
Ingelsson, E., LIND, L., Ärnlöv, J., & Sundström, J. (2006) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2006.05.010 · Cited by 44
Rich, M. W. (2006) · Medical Clinics of North America · doi:10.1016/j.mcna.2006.05.012 · Cited by 44
CYP3A5 polymorphism, amlodipine and hypertension
Zhang, Y.-P., Zuo, X.-C., Huang, Z.-J., Cai, J.-J., Wen, J., Duan, D. D., & Yuan, H. (2013) · Journal of Human Hypertension · doi:10.1038/jhh.2013.67 · Cited by 45
Muus, K. J., Knudson, A. D., Klug, M. G., Gokun, J., Vaughan‐Sarrazin, M., & Kaboli, P. J. (2010) · Rural and Remote Health · doi:10.22605/rrh1447 · Cited by 44
Seymour, E., Singer, A. A. M., Bennink, M. R., Parikh, R. V., Kirakosyan, A., Kaufman, P. B., & Bolling, S. F. (2008) · The Journals of Gerontology Series A · doi:10.1093/gerona/63.10.1034 · Cited by 43
“More than 90% of heart failure cases are preceded by prolonged hypertension (2).”
BackgroundGeographic Disparities in Heart Failure Hospitalization Rates Among Medicare Beneficiaries
Casper, M. L., Nwaise, I. A., Croft, J. B., Hong, Y., Fang, J., & Greer, S. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.10.021 · Cited by 43
Homocysteine and Heart Failure: An Overview
Vizzardi, E., Bonadei, I., Zanini, G., Frattini, S., Fiorina, C., Raddino, R., & Cas, L. (2009) · Recent Advances in Cardiovascular Drug Discovery (Formerly Recent Patents on Cardiovascular Drug Discovery) · doi:10.2174/157489009787259991 · Cited by 45
“Elevated homocysteine concentration is a risk factor for coronary atherosclerosis and myocardial infarction the latter being a key antecedent of CHF [59].”
BackgroundChronic heart failure and exercise
Kokkinos, P. F., Choucair, W. K., Graves, P. R. T., Papademetriou, V., & Ellahham, S. (2000) · American Heart Journal · doi:10.1067/mhj.2000.106916 · Cited by 43
Morbidity and mortality in diabetic patients following cardiac transplantation
Lang, C. C., Beniaminovitz, A., Edwards, N. M., & MANCINI, D. M. (2003) · The Journal of Heart and Lung Transplantation · doi:10.1016/s1053-2498(02)00567-3 · Cited by 43
Valsartan: a novel angiotensin Type 1 receptor antagonist
Thürmann, P. (2000) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.1.2.337 · Cited by 43
“High blood pressure remains a serious health problem leading to heart disease, stroke, end stage renal failure and retinopathy [1,2].”
BackgroundHernández, J. M., Shen, E. Y., Ko, C. Y., Hourani, Z., Spencer, E. R., Smoliarchuk, D., Bossuyt, J., Granzier, H. L. M., Bers, D. M., & Hegyi, B. (2024) · Cardiovascular Research · doi:10.1093/cvr/cvae070 · Cited by 42
“7 Hypertension increases HF risk by three-fold in women compared with two-fold in men, 8 and diabetes mellitus increases HF risk by five-fold in women compared with 2.4-fold in men.”
InfluentialClinical Trials in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction
Cleland, J. G. F., Pellicori, P., & Dierckx, R. (2014) · Heart Failure Clinics · doi:10.1016/j.hfc.2014.04.011 · Cited by 44
Deregulation of RGS2 in cardiovascular diseases
Xiao, R.-P. (2009) · Frontiers in Bioscience-Scholar · doi:10.2741/s84 · Cited by 42
“The Role of RGS2 and Cardiovascular Disease 3.1 Deregulation of RGS2 in the vascular system and hypertension Hypertension is a major risk factor for ischemic heart diseases and a strong predictor of hospitalization for congestive heart failure (CHF) (46).”
InfluentialShen, C., Wang, C., Fan, F., Yang, Z., Cao, Q., Liu, X., Sun, X., Zhao, X., Wang, P., Ma, X., et al. (2014) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2014.07.014 · Cited by 41
Seymour, E., Bennink, M. R., & Bolling, S. F. (2013) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2013.01.008 · Cited by 42
“Over 90% of heart failure cases are preceded by prolonged hypertension[2].”
BackgroundHai, J. J., Chan, P., Huang, D., Ho, M.-H., Ho, C. W., Cheung, E. H.-L., Lau, C., Tse, H., & Siu, C. (2016) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2016.03.007 · Cited by 40
Genetic and phenotypic determinants of blood pressure and other cardiovascular risk factors
Conen, D., Schön, T., Aeschbacher, S., Paré, G., Frehner, W., Risch, M., & Risch, L. (2012) · Swiss Medical Weekly · doi:10.4414/smw.2013.13728 · Cited by 41
Williams, A. M., Manouchehri, N., Erskine, E., Tauh, K., So, K., Shortt, K., Webster, M., Fisk, S., Billingsley, A., Munro, A. I., et al. (2020) · Nature Communications · doi:10.1038/s41467-020-18905-8 · Cited by 44
Niiranen, T., Jula, A., Kantola, I. M., Karanko, H., & Reunanen, A. (2007) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1002192 · Cited by 41
Kumar, A., & Lloyd‐Jones, D. M. (2007) · Cardiology in Review · doi:10.1097/01.crd.0000249382.65955.14 · Cited by 42
“Age-related changes in autonomic function, with higher levels of circulating catecholamine levels in elderly subjects, may also contribute to the higher prevalence of minor NSSTTA in the elderly.38,43 The association between minor NSSTTA and CHF incidence in the elderly, an association observed only in subjects withou…”
BackgroundInfluentialRenal Artery Stenosis: Epidemiology, Clinical Manifestation, and Percutaneous Endovascular Therapy
Zeller, T. (2005) · Journal of Interventional Cardiology · doi:10.1111/j.1540-8183.2005.00092.x · Cited by 42
Hospitalized Congestive Heart Failure after Renal Transplantation in the United States
Abbott, K. C., Hypolite, I. O., Hshieh, P., Cruess, D. F., Taylor, A. J., & Agodoa, L. Y. C. (2002) · Annals of Epidemiology · doi:10.1016/s1047-2797(01)00272-1 · Cited by 42
Ionizing radiation and genetic risks
Sankaranarayanan, K., Chakraborty, R., & Boerwinkle, E. (1999) · Mutation Research/Reviews in Mutation Research · doi:10.1016/s1383-5742(98)00017-9 · Cited by 42
RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus
Kumar, V., Agarwal, S., Saboo, B., & Makkar, B. M. (2022) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-022-01143-7 · Cited by 47
“High blood pressure can also lead to high prevalence of atrial fibrillation [62], ventricular arrhythmias [63], and a sixfold greater risk of myocardial infarction [64], and subsequent heart failure with reduced ejection fraction (HFrEF).”
Backgroundvan Ommen, A. M. L. N., Canto, E. D., Cramer, M. J., Rutten, F. H., Onland‐Moret, N. C., & den Ruijter, H. M. (2022) · BMC Medicine · doi:10.1186/s12916-022-02650-4 · Cited by 43
“Hypertension Women with hypertension have higher HF risk [23], HF risk increases at SBP ≥ 110 mmHg in women [24]”
Background
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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