September 15, 2015
How do we predict cardiovascular events in the young and middle age people? Presently, we use patient, family, and social history, serum-based biomarkers, imaging scans, and physical findings. It is the latter marker that researchers have recently studied, namely systolic blood pressure that may be important, especially in younger age groups.
Systolic blood pressure is a measure of arterial pressure when the heart beats or pumps blood to the systemic circulation. Isolated systolic hypertension (ISH) is defined as a systolic blood pressure ≥ 140 mmHg with a diastolic blood pressure < 90 mmHg. This is normally seen in older adults as a result of underlying conditions such as artery stiffness, heart valve problems, or an overactive thyroid (hyperthyroidism). Importantly, ISH has been increasing in the United States in younger age groups (<40 years of age), more than doubling from 1999 to 2004.1 Data from the United States and Sweden show that high systolic and/or diastolic blood pressures in younger adults, but not ISH specifically, are related to a greater risk of cardiovascular mortality.2-6
A recent study of ISH in young and middle-aged adults form the Chicago Heart Association Detection Project in Industry shows that over a 31-year follow-up of 842,600 person-years there was a 23% (95% CI: 1.03-1.46) and 28% (95% CI: 1.04-1.58) increased risk of cardiovascular and coronary heart disease mortality with the presence of ISH. In women, the risk was higher at 1.55 (95% CI: 1.18-2.05) and 2.12 (95% CI: 1.49-3.01). Models were adjusted for age, race, education, BMI, current smoking, total cholesterol, and diabetes. The risks of ISH were higher than with high-normal BP, isolated diastolic hypertension, but less than those associated with systolic-diastolic hypertension.
Let’s put the findings in context. These results do not suggest that treating younger ISH patients is warranted with antihypertensive treatment. However, lifestyle changes should be recommended, especially in patients with concomitant obesity, diabetes, smoking history, or hyperlipidemia. If after a sufficient trial length of lifestyle changes the systolic blood pressure is not lowered, antihypertensive therapy should be considered, especially in women. These results suggest that we are starting to uncover cardiovascular risk factors at an early age, which will hopefully lead to early treatment with later reductions in morbidity and mortality being realized.
Mark A. Munger, PharmD, FCCP, FACC, is a Professor of Pharmacotherapy and Adjunct Professor of Internal Medicine, at the University of Utah, where he also serves as the Associate Dean, Academic Affairs for the College of Pharmacy.
1. Grebla RC, Rodriquez CJ, Borrell LN, Pickering TG. Prevalence and determinants of isolated systolic hypertension among young adults: the 1999-2004 U.S. National Health and Nutrition Examination Survey. J Hypertens. 2010;28(1):15-23.
2. Paffenbarger RS Jr, Notkin J, Krueger DE, et al. Chronic disease in former college students. II. Methods of study and observations on mortality from coronary heart disease. Am J Public Health Nations Health. 1966;56(6):962-971.
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5. Sundstrӧm J, Neovius M, Tynel P, Rasmussen F. Association of blood pressure in late adolescence with subsequent mortality; cohort study of Swedish male conscripts. BMJ.2011;342:d643.
6. Gray L, Lee IM, Sesso HD, Batty GD. Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality. HAHS (Harvard Alumni Health Study). J Am Coll Cardiol. 2011;58(23):2396-2403.