JACC in a Flash | Young adults with prolonged elevated blood pressure (BP), even at levels considered to be within normal range, are more likely to show signs of left ventricular systolic and diastolic dysfunction in middle age. These findings, published in JACC, raise questions about the importance of BP monitoring earlier in life.

Researchers from the Coronary Artery Risk Development in Young Adults (CARDIA) study examined 2,479 men and women aged 18 to 30 years old for 25 years beginning in 1985 and 1986. During the study period, they conducted seven health assessments, which included BP readings. The researchers then calculated the cumulative exposure of BP for each participant over the duration of the study. At the end of the study period, sonographers performed echocardiography to measure the condition of the participants’ hearts.

Researchers found that participants who had BP that was on the higher end of the normal range in young adulthood were more likely to have left ventricle dysfunction in middle age. There was a greater effect of cumulative BP exposure on diastolic compared to systolic myocardial function in this healthy population, and a greater effect of diastolic versus systolic BP elevation on both systolic and diastolic left ventricular function. Researchers said their work suggests young adults should take steps to reduce elevated BP by reducing sodium intake, maintaining an ideal body weight, being physically active and adhering to any recommended medical treatments for high BP.

The study also demonstrates that the use of speckle-tracking data and left ventricular dysfunction can help use better understand the adverse effects of cumulative BP exposure that ejection fraction alone does not identify.

A limitation of the study is that it relied on subclinical endpoints, and the researchers add that additional research is needed to validate the results using clinical endpoints.

“Our findings provide further support for the importance of good risk factor control early in life,” said João A.C. Lima, MD, FACC, an author of the study. “Many participants were not hypertensive at the beginning of the study; however, chronic exposure to higher BP, even within what is considered the normal range, is associated with cardiac dysfunction 25 years later.”

“The CARDIA study confirms the very important link between BP over time and the development of left ventricular dysfunction,” said Lee Goldber, MD, FACC, Chair of the ACC’s Heart Failure and Transplant Section Leadership Council. “The study suggests that screening and subsequent treatment of BP in young adults can have a huge public health benefit. In particular, focusing on diastolic BP in young people and perhaps using a lower threshold for treatment may prevent heart failure later in life. The conclusions suggest that additional studies should be done and the guidelines for treatment of BP in young adults may need to be revised.”

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Kishi S, Teixido-Tura G, Ning H, et al. J Am Coll Cardiol. 2015;65(25):2679-87.

Keywords: CardioSource WorldNews, ACC Publications, Blood Pressure, Cardiomyopathies, Heart Ventricles, Diastole

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