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Elevated BP in Young Adults and CVD Events Later in Life
Study Questions:
Do adults under the age of 40 years with hypertension (HTN) have a greater risk for cardiovascular disease (CVD) events compared to those who maintain a normal blood pressure (BP)?
Methods:
Data from the CARDIA (Coronary Artery Risk Development in Young Adults) study were used for the present analysis. CARDIA is a prospective cohort study started in March of 1985, which enrolled African American and white participants ages 18-30 years from four US areas. BP was measured from the first examination to the examination closest to but not after the age of 40 years for each participant. BP was categorized as normal (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg), elevated BP (untreated SBP 120-129 mm Hg and DPB <80 mm Hg), stage I HTN (untreated SPB 130-139 mm Hg or DBP 80-89 mm Hg), or stage 2 HTN (SBP ≥140 mm Hg or DPB ≥90 mm Hg or taking antihypertensive medications). The primary outcomes of CVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD) were assessed through August of 2015.
Results:
A total of 4,851 adults were in the final cohort, of which 2,574 had normal BP, 445 had elevated BP, 1,194 had stage 1 HTN, and 638 had stage 2 HTN. The cohort’s mean age was 35.7 years, 2,657 were women [55%], and 2,441 were African American [50%]. A total of 206 participants were taking antihypertensive medication (4%). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (CHD, 109; stroke, 63; heart failure, 48; PAD, 8). CVD incidence rates for normal BP, elevated BP, stage 1 HTN, and stage 2 HTN were 1.37 (95% confidence interval [CI], 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1,000 person-years, respectively. In multivariate models adjusting for potentional confounders, the risk for CVD events (compared to those with normal BP) increased from hazard ratio (HR) 1.67 (95% CI, 1.01-2.77) for elevated BP, to HR 1.75 (95% CI, 1.22-2.53) for stage 1 HTN, and HR 3.49 (95% CI, 2.42-5.05) for stage 2 HTN.
Conclusions:
The authors concluded that among young adults, those with elevated BP, stage 1 HTN, and stage 2 HTN before age 40 years, as defined by the BP classification in the 2017 American College of Cardiology/American Heart Association guidelines, had significantly higher risk for subsequent CVD events compared with those with normal BP before age 40 years.
Perspective:
These data support the recommendation to identify increases in BP among young adults and to support patients in lifestyle modification to maintain normal BP.
Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Hypertension
Keywords: Antihypertensive Agents, Blood Pressure, Coronary Disease, Heart Failure, Hypertension, Ischemic Attack, Transient, Life Style, Metabolic Syndrome, Peripheral Arterial Disease, Primary Prevention, Risk, Stroke, Young Adult
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