Young-ISH Patients: Late Risk of Early Hypertension; Decades of follow-up show risk of isolated systolic hypertension in young adults
JACC in a Flash | Does isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) ≥140 mm Hg and diastolic BP (DBP) <90 mm Hg, increase the risk of cardiovascular events in younger and middle-aged adults? This was the question, the Chicago Heart Association Detection Project in Industry Study group assessed in a recent study published in JACC.
The study looked at 15,868 men and 11,213 women who were 18-49 years of age (mean age 34 years) at baseline and who were free of coronary heart disease (CHD) and antihypertensive therapy. Participant classifications were: 1) optimal-normal BP (SBP <130 and DBP <85 mm Hg); 2) high-normal BP (130-139/85-89 mm Hg); 3) ISH; 4) isolated diastolic hypertension (IDH; SBP <140 and DBP ≥90 mm Hg); and 5) systolic diastolic hypertension (SDH; SBP ≥140 and DBP ≥90 mm Hg.
Overall, results found that during a 31-year average follow-up, there were 1,728 deaths from cardiovascular disease, 1,168 from CHD and 223 from stroke. Cox proportional hazards models were adjusted for: age, race, education, body mass index, current smoking, total cholesterol, and diabetes. In men, with optimal-normal BP as the reference stratum, hazard ratios (HRs) and 95% confidence intervals (CIs) of cardiovascular disease and CHD mortality risk for those with ISH were 1.23 (1.03-1.46) and 1.28 (1.04-1.58), respectively. ISH risks were similar to those with high-normal BP and less than those associated with IDH/SDH. In women with ISH, HRs (95% CIs) of cardiovascular disease and CHD mortality risk were 1.55 (1.18-2.05) and 2.12 (1.49-3.01), respectively. ISH risks were higher than in those with high-normal BP/IDH, and less than as those associated with SDH.
According to the study authors, these findings suggest that over long-term follow-up, younger and middle-aged adults with ISH had higher relative risk of cardiovascular disease and CHD mortality than those with optimal-normal BP. "The study is novel in that few studies have evaluated the impact of ISH among a younger cohort and directly compared it with other groups," said Melvyn Rubenfire, MD, in an ACC Journal Scan on ACC.org. "The findings demonstrate that the hemodynamics of ISH are not innocent, even among a younger cohort, and that treatment of ISH among younger lower-risk patients may need to be tested."
- Yano Y, Stamler J, Garside D, et al. J Am Coll Cardiol. 2015;65:327-35.
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