AIM: Young adults with prehypertension are more likely to develop atherosclerosis

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Prehypertension during young adulthood is common and is associated with coronary atherosclerosis 20 years later, according to a study published in the July 15 issue of the Annals of Internal Medicine.

Mark J. Pletcher, MD, MPH, from the University of California, San Francisco, and colleagues conducted a prospective cohort study of black and white men and women, age 18 to 30 years, for the CARDIA (Coronary Artery Risk Development In young Adults) study in 1985 through 1986, who were without hypertension before age 35.

The researchers estimated the blood pressure trajectories for each participant by using measurements from seven examinations over the course of 20 years. Cumulative exposure to blood pressure in the prehypertension range (systolic blood pressure of 120 to 139 mm Hg, or diastolic blood pressure of 80 to 89 mm Hg) from age 20 to 35 years was calculated in units of mm Hg–years (similar to pack-years of tobacco exposure) and related to the presence of coronary calcium measured at each participant's last exam, according to the authors.

Among 3560 participants, the researchers found that 635 (18 percent), who developed prehypertension before age 35 years were more often black, male, overweight and of lower socioeconomic status.

Pletcher and colleagues found that the exposure to prehypertension before age 35 years, especially systolic prehypertension, showed a graded association with coronary calcium later in life. The association remained strong after adjustment for blood pressure elevation after age 35 years and other coronary risk factors and participant characteristics, according to the investigators.

The authors wrote that participants with low annual income (less than $25,000) and no college education were about twice as likely to have had early prehypertension as were participants with postgraduate education and an annual income greater than $100,000.

The researchers said that their study was limited because not all patients with coronary artery calcium develop clinically significant cardiovascular disease.

Pletcher and colleagues concluded that keeping systolic pressure below 120 mm Hg before age 35 years may provide important health benefits later in life.