Serum fibroblast growth factor-23 and incident hypertension: The Atherosclerosis Risk in Communities (ARIC) Study

Amber L. Fyfe-Johnson, Alvaro Alonso, Elizabeth Selvin, Julie K. Bower, James S. Pankow, Sunil K. Agarwal, Pamela L. Lutsey

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objective:: Elevated serum fibroblast growth factor-23 (FGF23), an endogenous hormone, is associated with disturbed mineral homeostasis, cardiovascular disease, and chronic kidney disease. It is unclear whether FGF23 impacts the development of incident hypertension. We examined the association between elevated FGF23 and incident hypertension in a community-based cohort. Method: We investigated the association of serum FGF23, measured at baseline (1990-1992), with incident hypertension at two follow-up visits (1993-1995 and 1996-1998) in 7948 middle-aged men and women without hypertension at baseline participating in the Atherosclerosis Risk in Communities Study. Incident hypertension was determined by measured blood pressure (DBP≥90mmHg or SBP≥140mmHg) and/or self-reported hypertension medication use at follow-up exams. Complementary log-log models that accounted for interval censoring were used to model the association between FGF23 and incident hypertension. Results: During a median follow-up of 5.9 years, 27% (2152/7948) participants developed hypertension. A nonlinear association between serum FGF23 and incident hypertension was observed; only persons in the highest decile of serum FGF23 had an increased risk of incident hypertension. After adjustment for demographics, behaviors, and adiposity, the hazard ratio for incident hypertension was 1.24 (95% confidence interval: 1.11, 1.39) for the highest decile of FGF23 compared with the lowest quintile. The association was further attenuated in the final model after adjusting for renal function (hazard ratio: 1.21, 95% confidence interval: 1.08, 1.35). Conclusion:: High levels (≥60.6pg/ml) of FGF23 are associated with a modestly increased risk of incident hypertension in the general population, independent of kidney function.

Original languageEnglish (US)
Pages (from-to)1266-1272
Number of pages7
JournalJournal of hypertension
Issue number7
StatePublished - Jul 1 2016

Bibliographical note

Funding Information:
Measurement of FGF23 and some of the related biomarkers was supported through a grant from the National Heart, Lung, and Blood Institute, R01 HL103706 (Lutsey, PI). Cystatin C and CRP were measured as part of a grant from the National Institute of Diabetes and Digestive andKidney Disease R01DK089174 (Selvin, PI). The Atherosclerosis Risk in Communities Study is a multicenter collaborative study supported by National Heart, Lung, and Blood Institute contracts, HHSN268201100005C, HHSN268 201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN26820 1100011C, and HHSN268201100012C. The trainee was supported by a National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL07779 (Folsom, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc.


  • Atherosclerosis Risk in Communities Study
  • fibroblast growth factor-23
  • fibroblast growth factors
  • hypertension
  • risk factors


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