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. 2017 Aug 1;38(29):2300-2308.
doi: 10.1093/eurheartj/ehx134.

Risk for hypertension crosses generations in the community: a multi-generational cohort study

Teemu J Niiranen  1   2 , Elizabeth L McCabe  3 , Martin G Larson  2   3 , Mir Henglin  4 , Neal K Lakdawala  4 , Ramachandran S Vasan  2   5   6   7 , Susan Cheng  2   4
Affiliations

Risk for hypertension crosses generations in the community: a multi-generational cohort study

Teemu J Niiranen et al. Eur Heart J. .

Abstract

Aims: Parental hypertension is known to predict high blood pressure (BP) in children. However, the extent to which risk for hypertension is conferred across multiple generations, notwithstanding the impact of environmental factors, is unclear. Our objective was therefore to evaluate the degree to which risk for hypertension extends across multiple generations of individuals in the community.

Methods and results: We studied three generations of Framingham Heart Study participants with standardized blood pressure measurements performed at serial examinations spanning 5 decades (1948 through 2005): First Generation (n = 1809), Second Generation (n = 2631), and Third Generation (n = 3608, mean age 39 years, 53% women). To capture a more precise estimate of conferrable risk, we defined early-onset hypertension (age <55 years) as the primary exposure. In multinomial logistic regression models adjusting for standard risk factors as well as physical activity and daily intake of dietary sodium, risk for hypertension in the Third Generation was conferred simultaneously by presence of early-onset hypertension in parents [OR 2.10 (95% CI, 1.66-2.67), P < 0.001] as well as in grandparents [OR 1.33 (95% CI, 1.12-1.58), P < 0.01].

Conclusion: Early-onset hypertension in grandparents raises the risk for hypertension in grandchildren, even after adjusting for early-onset hypertension in parents and lifestyle factors. These results suggest that a substantial familial predisposition for hypertension exists, and this predisposition is not identical when assessed from one generation to the next. Additional studies are needed to elucidate the mechanisms underlying transgenerational risk for hypertension and its clinical implications.

Keywords: Blood pressure; Environment; Genetics; Heritability; Hypertension.

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Figures

Figure 1
Figure 1
Individuals included in the main analyses comprised of Third Generation Cohort participants with objectively collected data on parental and grandparental blood pressure measures. Several Third Generation participants may have had a common parent or grandparent.
Figure 2
Figure 2
Prevalence of normal blood pressure or hypertension in third generation by parental and grandparental early-onset hypertension status. HTN, hypertension; BP, blood pressure.
Figure 3
Figure 3
The last reported geographic location of residence, across North America and in the state of Massachusetts for all three generations of participants included in the analyses.
Figure 4
Figure 4
Transmission of hypertension risk across generations. Our findings suggest that a predisposition for developing hypertension persists across generations with a proportion of risk that is passed down from grandparent to grandchild, notwithstanding the traits that are passed down from parent to child. Further studies are needed to investigate the relative importance of contributors to hypertension risk that persist across generations.
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