Are Young and Middle-Aged Adults With Isolated Systolic HTN at Risk For CVD Mortality?

Adults between the ages of 18 to 49 with isolated systolic hypertension (ISH) may have a higher risk of mortality from cardiovascular disease or coronary heart disease (CHD), according to a study published Jan. 26 in the Journal of the American College of Cardiology.

Using data recorded between 1967 and 2003 in the Chicago Heart Association Detection Project in Industry study, researchers examined the risk of cardiovascular disease with ISH – defined as systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) less than 90 mmHg – in younger and middle-aged men and women. At baseline, 27,081 participants were classified based on their blood pressure into five categories: optimal-normal BP (SBP <130, DBP <85 mmHg); high-normal BP (130 – 139/85 – 89 mmHg); ISH; isolated diastolic hypertension (IDH; SBP <140 and ≥90 mmHg); and systolic diastolic hypertension (SDH; SBP ≥140 and DBP ≥90 mmHg). Of note, 53 percent of female participants had optimal-normal BP and 13 percent had ISH at baseline, while approximately 25 percent of male participants had optimal-normal, high-normal and ISH each. Researchers excluded those with pre-existing CHD, participants taking antihypertensive drugs, and those with incomplete baseline data.

The results of the study showed that after a 31 year follow-up, participants with ISH at baseline were at higher risk for cardiovascular disease or CHD mortality compared to those with optimal-normal BP or high-normal BP/IDH. However, this risk in ISH patients was less than those with SDH. Over the 31 year follow-up period, 1,728 participants died from cardiovascular disease, while 1,168 died from CHD. The cardiovascular disease mortality risk for ISH as compared to high-normal BP was greater in female participants than male. Further, the study showed the “relative risk of cardiovascular disease mortality was highest for SDH followed by IDH.”

“Until now, physicians have not considered isolated systolic hypertension to be bad, but this study shows higher risk,” said the study’s lead author Yuichiro Yano, MD, of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago. “By identifying risks in younger populations, they can be made aware of the need to maintain cardiovascular health as they age.”

The authors note that moving forward, “further research is needed, including clinical trials and studies seeking better ways... to identify younger and middle-aged adults with ISH who are at especially high risk for developing cardiovascular disease events.”

A related editorial comment by Michael A. Weber, MD, FACC, Division of Cardiovascular Medicine, State University of New York, notes that, “a lesson from the study of Yano and colleagues is that even in a young (mid-30s) cohort, systolic BPs and CHD death have a relationship resembling that in the Prospective Studies Collaboration, in which systolic BP increments of 20 mmHg were associated with an approximate doubling of CHD risk.”

Weber concludes that “the growing prevalence of hypertension, along with obesity, lipid disorders, and diabetes in young people has become a major public health issue... [Therefore,] early management of hypertension in young adults might alter its natural history and reduce the incidence of cardiovascular events in later life.”

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Chicago, Coronary Disease, Diabetes Mellitus, Diastole, Follow-Up Studies, Hypertension, Incidence, Lipids, Middle Aged, Obesity, Prevalence, Prospective Studies, Public Health, Research Personnel, Risk, Systole, United States, Universities

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