Hypertension in College Linked to CHD Deaths in Midlife

Shelley Wood

November 22, 2011

November 21, 2011 (Glasgow, Scotland) — Young men with prehypertension or hypertension during their college years--half a century ago--were significantly more likely to die of coronary heart disease than their normotensive counterparts, a new analysis shows [1].

The study, published in the November 29, 2011 issue of the Journal of the American College of Cardiology, looked at health outcomes among almost 19 000 men who had their blood pressure measured back in the mid-1960s, when they were in their late teens.

Dr Linsay Gray (Social and Public Health Sciences Unit, Glasgow, Scotland) and colleagues report that risks of dying from any cause, from cardiovascular disease (CVD), and coronary heart disease (CHD) were all increased among men who had higher blood-pressure levels decades earlier, with risk increasing across hypertension categories. One surprise, however, in the Harvard Alumni Health Study, was that stroke mortality was not significantly increased among those with elevated blood pressure decades earlier.

Hazard Ratios (95% CI) for Mortality, Across Blood-Pressure Levels

Cause of death Prehypertensive Stage 1 hypertensive Stage 2 hypertensive p for trend
CHD 1.21 (1.07–1.36) 1.46 (1.25–1.70) 1.89 (1.46–2.45) <0.001
Stroke 0.99 (0.80–1.22) 1.28 (0.98–1.67) 1.28 (0.78–2.09) 0.082

Prehypertensive: 120–139/80–89 mm Hg; stage 1 hypertension (140–159/90–99 mm Hg; stage 2 hypertension, >160/>100 mm Hg

"The lack of an association between university blood pressure and total stroke mortality is surprising," Gray and colleagues concede. The "weaker" association between baseline BP and stroke, as compared with CHD, "may reflect blood-pressure–related atherosclerosis taking place earlier in adulthood compared with the antecedents of stroke," they write.

Nevertheless, they say, the findings "appear to persist even after accounting for self-reported hypertension in middle age" and "lend weight to blood-pressure–lowering strategies beginning earlier in the life course than is currently the case."

Of note, add Gray et all, there are very little prospective clinical-trial data supporting a strategy of blood-pressure lowering in younger adults--a knowledge gap also highlighted in an accompanying editorial by Drs Kirsten Bibbins-Domingo and Mark J Pletcher (University of California, San Francisco) [2]. They point out that the lack of clinical-trial evidence supporting the safety and efficacy of BP lowering in younger adults is even more pressing now, given the rising levels of hypertension and obesity in childhood and adolescence.

They also highlight a key flaw in Gray et al's analysis: namely, that blood pressures in the 1960s were determined on the basis of a mailed survey--a factor that could have skewed the findings. That said, they continue, the primary hypothesis "that blood pressure matters during young adulthood" is likely correct, the editorialists say, and needs to be swiftly addressed.

"Harvard students started having their blood pressure measured for this study in 1914," Bibbins-Domingo and Pletcher write. "Now, nearly a century later, their message about the importance of blood pressure in young adults has been received, and despite the transmission delay, it is a message with more public-health relevance than ever."


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