High systolic blood pressure puts young, middle-aged at risk

Younger patients with high systolic blood pressure may have a higher cardiovascular risk profile than previously believed. This statement comes out of results from a more than 30-year population study following Chicago-area workers.

Of the more than 39,000 participants in the Chicago Heart Association Detection in Industry study, 27,081 had no history of cardiovascular disease and were not on antihypertensive medications at baseline. Follow-up occurred through 2003, averaging about 31 years. The long-range study included patients from age 18 through 49 years at baseline. In all, Yuichiro Yano, MD, PhD, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues found five blood pressure categories: optimal-normal, high-normal, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic diastolic hypertension (SDH).

Optimal blood pressure was defined as below 130 mm Hg for systolic blood pressure and below 85 mm Hg for diastolic blood pressure. High-normal could be defined as having either or both systolic or diastolic blood pressure in an elevated range (systolic between 130 and 139 mm Hg, diastolic between 85 and 89 mm Hg). In ISH or DSH, one blood pressure measurement was normal while the other was above elevated range (systolic equal to or more than 140, diastolic equal to or more than 90), meanwhile, SDH was defined as both measurements above elevated.

Cardiovascular disease mortality risk for all patients was highest with SDH (1.77). However, it was closely followed by IDH (1.68), then high-normal blood pressure (1.25) and ISH (1.23). High systolic blood pressure increased risks for cardiovascular death by 23 percent for men and 55 percent for women.

For men younger than 40 years old with ISH, the mortality risk was 1.27; older than 40 years, 1.18. In women, age-related ISH cardiovascular mortality risks were reversed: under 40, 1.15; over 40, 1.68.

An editorial written by Michael Weber, MD, from the State University of New York Downstate College of Medicine in Brooklyn, noted that the data from this study fill a critical gap in knowledge. “[T]he growing prevalence of hypertension, along with obesity, lipid disorders, and diabetes, in young people has become a major public health issue. Indeed, it is to be hoped that early management of hypertension in young adults might beneficially alter its natural history and reduce the incidence of cardiovascular events in later life,” Weber wrote.

The study, published in the Feb. 3 issue of the Journal of the American College of Cardiology, started in 1967, before the obesity epidemic.

“This study found consistently higher body mass index and cholesterol levels in young and middle-aged adults with isolated systolic hypertension. Obesity was not the main focus of this study, but our research resulted in very interesting data,” stated Yano in a press release.

For this reason, Yano et al wrote that further research to identify the younger and middle-aged patients at the most risk for cardiovascular disease events due to elevated and high systolic blood pressure is needed.