Elevated blood pressure in young adulthood increases likelihood of cardiac dysfunction

Young adults with elevated levels of blood pressure were more likely to have left ventricular (LV) systolic and diastolic dysfunction in middle age, according to a prospective study that tracked people over 25 years.

João A.C. Lima, MD, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues published their findings online in the Journal of the American College of Cardiology on June 22.

They noted that controlling diastolic blood pressure in young adults might help prevent LV dysfunction and heart failure.

“Our findings provide further support for the importance of good risk factor control early in life,” Lima said in a news release. “Many participants were not hypertensive at the beginning of the study; however, chronic exposure to higher blood pressure, even within what is considered the normal range, is associated with cardiac dysfunction 25 years later.”

The CARDIA (Coronary Artery Risk Development in Young Adults) trial included 5,115 healthy African American and white young adults. They were between 18 and 30 years old when they enrolled in 1985 and 1986 at centers in Birmingham, Ala., Oakland, Calif., Chicago and Minneapolis.

After 25 years, the researchers evaluated the 2,479 participants who had completed seven examinations since enrolling. They measured LV function with Doppler echocardiography and 2-dimensional–guided M-mode echocardiography.

The mean age at the 25-year examination was 50. In addition, 56.8 percent of participants were women and 60 percent were white.

Lima et al found that systolic blood pressure increased after 35 years of age, while diastolic blood pressure and mean arterial pressure increased from baseline to the fourth decade and then remained consistent. Meanwhile, pulse pressure decreased until participants were 40, and then it began increasing.

Compared with white participants, African Americans had higher systolic blood pressure, diastolic blood pressure and mean arterial pressure.

They wrote that cumulative exposure to blood pressure was associated with reduced global systolic myocardial LV function, although it was not associated with a reduction in left ventricular ejection fraction.

“This study shows that the use of speckle-tracking data and LV dysfunction help us better understand the adverse effects of cumulated (blood pressure) exposure that ejection fraction alone does not identify,” they wrote.