Can high blood pressure when younger affect CVD risk later in life?
New study findings align with new ACC/AHA BP guideline
Little is known about the association between level of blood pressure (BP) in young adulthood and cardiovascular disease (CVD) events by middle age, said researchers in a study published in JAMA on November 6. Yuichiro Yano and colleagues assessed whether young adults who developed hypertension, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, before age 40 have higher risk for CVD events compared with those who maintained normal BP. They found that young adults with elevated blood pressure, stage 1 hypertension, or stage 2 hypertension before age 40 years had significantly higher risk for subsequent
CVD events compared with those with normal blood pressure before age 40.
Results were obtained from the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, started in March 1985, which enrolled 5,115 black and white participants aged 18 to 30 years from four U.S. field centers (Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA). Each participant was categorized as having normal BP (untreated SBP < 120 mm Hg and DBP < 80 mm Hg); elevated BP (untreated SBP 120–129 mm Hg and DPB < 80mm Hg), stage 1 hypertension (untreated SBP 130–139 mm Hg or DBP 80–89 mm Hg), or stage 2 hypertension (SBP ≥ 140 mm Hg, DBP ≥ 90 mm Hg, or taking antihypertensive medication) using the BP measurement closest to, but not after, age 40 years.
Outcomes were available through August 2015. The final cohort included 4,851 adults (2,657 women [55%]; 2,441 African American [50%]; and 206 taking antihypertensive medication [4%]). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (coronary heart disease, 109; stroke, 63; heart failure, 48; peripheral artery disease, 8) with hazard ratios for CVD events for elevated BP, stage 1 hypertension, and stage 2 hypertension versus normal BP at 1.67, 1.75, 3.49, respectively. The authors concluded that the ACC/AHA blood pressure classification system may help identify young adults at higher risk for CVD events.