Isolated Systolic Hypertension in Young Adults Ups CVD Risk

Marlene Busko

January 30, 2015

CHICAGO, IL — Sustained isolated systolic hypertension (ISH) in young and middle-aged adults "is not an innocuous condition," according to researchers, defining ISH as systolic blood pressure greater than or equal to 140 mm Hg when diastolic blood pressure is less than 90 mm Hg[1].

Their analysis based on outcomes from 18- to 49-year-olds in the Chicago Heart Association Detection Project in Industry Study showed that men and women with ISH had a much higher risk of dying from coronary heart disease or CV disease during a 31-year follow-up compared with their peers with normal-optimal blood pressure; women had an especially high risk.

"This is clearly the best evidence to date to suggest that clinicians should be screening for [ISH in young and middle-aged adults] and pay careful attention to it," senior author Dr Donald M Lloyd-Jones (Northwestern University, Chicago, IL) told heartwire .

"I think this is going to raise awareness that we can't just say 'Well, this person is young; we've got time to think about this blood pressure later.' I think we should certainly get more aggressive with [recommending] lifestyle [changes] and have careful consideration of medications if this is a sustained finding."

However, the study was observational and not designed to determine what type of treatment is warranted for these patients, lead author Yuichiro Yano (Northwestern University, Chicago) and colleagues caution, in this study published in the February 3, 2015 issue of the Journal of the American College of Cardiology.

They call for "clinical trials and studies seeking better ways (such as central BP monitoring or biomarkers) to identify younger and middle-aged adults with ISH who are at especially greater risk for developing CVD events."

ISH Less Common in Younger Adults

In people 50 and older, ISH is by far the most common form of hypertension that clinicians see; it is less common in younger adults, Lloyd-Jones explained. Whether ISH in younger adults is "pseudo," "spurious," or "benign white-coat" hypertension is unclear, largely because previous studies were done in small populations.

Yano and colleagues analyzed data from 15 868 men and 11 213 women who did not have CHD and were not taking antihypertensives when they were enrolled in 1967 to 1973. The participants had a mean age of 34, and 85% were non-Hispanic white.

Based on a single supine blood-pressure measurement, the participants were stratified into five blood-pressure categories: optimal-normal (<130/<85 mm Hg); high-normal (130–139/85–89 mm Hg); ISH (>140/<90 mm Hg), isolated diastolic hypertension (<140/>90 mm Hg), and systolic and diastolic hypertension (>140/>90 mm Hg).

One quarter of the men and 13% of the women had ISH. Those with ISH were more likely to smoke and have less education, higher body-mass index, and higher cholesterol compared with their peers with optimal-normal blood pressure.

During a 31-year average follow-up period, there were 1728 deaths from CVD, 1168 deaths from CHD, and 223 deaths from stroke.

Men with ISH were 23% more likely to die from CVD than men with optimal-normal blood pressure, and women with ISH were 55% more likely to die from CVD than women in the reference group, after adjustment for several confounders.

Men and especially women with ISH had a higher risk of dying from CHD than their peers in the reference group. Having ISH was not linked to an increased risk of dying from stroke.

Adjusted Hazard Ratio (95% CI) for Mortality, ISH vs Optimal-Normal Blood Pressure

Mortality type Men Women
CVD 1.23 (1.03–1.46) 1.55 (1.18–2.05)
CHD 1.28 (1.04–1.58) 2.12 (1.49–3.01)
Stroke 1.08 (0.62–1.90) 1.46 (0.76–2.82)
Adjusted for race and baseline age, education, body mass index, current smoking, total cholesterol, and diabetes

The researchers were somewhat surprised that ISH was not so rare in women, and these women had a much higher risk of CVD, Lloyd-Jones said, but this finding again emphasizes that "we don't want to ignore this in young folks, whether they are men or women."

Early Hypertension Management Needed

"ISH in younger people has largely been unrecognized, so this report resolves an important uncertainty," Dr Michael A Weber (State University of New York, Brooklyn, NY), agrees, writing in an accompanying editorial[2].

Based on current clinical hypertension guidelines, elevated systolic or diastolic blood pressure or both should clearly be considered abnormal in young adults and lead to therapy, he notes.

Despite relatively low rates of cardiovascular events in young people, "the growing prevalence of hypertension, along with obesity, lipid disorders, and diabetes, in young people has become a major public-health issue," according to Weber. Hopefully, "early management of hypertension in young adults might beneficially alter its natural history and reduce the incidence of cardiovascular events in later life."

This study was supported by the American Heart Association and its Chicago and Illinois affiliates; the National Heart, Lung, and Blood Institute; the Northwestern Memorial Foundation; and the Goldberg Family Charitable Trust. The authors and Weber have no relevant financial relationships.


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