Antecedent blood pressure as a predictor of cardiovascular disease

•We examine the benefit of antecedent blood pressure (BP) in cardiovascular disease risk prediction models.•Antecedent BP is a highly significant predictor in these models.•Current BP is not significant when antecedent pressure is a predictor.•Antecedent BP is a stronger predictor than current pressure.

Elevated blood pressure (BP) is associated with greater risk of cardiovascular disease (CVD), and evidence suggests that prior BP levels may be at least as important as current BP in prediction models. We analyzed the determinants of CVD risk in Offspring Framingham Heart Study participants (n = 3344). The baseline Cox model included the traditional risk factors and current systolic BP to predict 20-year risk of CVD (643 events). Current systolic BP was significant, and the associated hazard ratio was 1.09 for 10 mm Hg (confidence interval [CI] 95%: 1.04-1.15). A second model used the traditional risk factors plus antecedent BP (hazard ratio [HR] = 1.19; CI 95%: 1.10-1.24). In a third model that included traditional risk factors and both current and antecedent BP, the antecedent BP was significant (HR = 1.18; CI 95%: 1.08-1.23), but the current BP was not statistically significant (HR = 1.01; CI 95%: 0.97-1.09). Antecedent BP showed a significantly stronger effect on risk of CVD than current BP.