PORTLAND, OR — Being diagnosed with hypertension in middle age vs old age greatly increased the odds of dying from cardiovascular disease (CVD), especially coronary heart disease (CHD), rather than dying from other causes, in a new study based on data from the original Framingham Heart Study cohort[1].

The researchers identified 3614 participants who had regular blood-pressure measurements every 2 years from 1948 through 2005 and were now deceased.

Participants who had early-onset hypertension (diagnosed when they were 45 or younger) were more likely to have died from CVD or CHD than other causes than participants who had late-onset hypertension (diagnosed when they were 65 or older). However, having hypertension at any age upped the odds of dying from CVD or CHD.

Dr Teemu Niiranen (Framingham Heart Study, MA) presented these findings in a poster here at the EPI|LIFESTYLE 2017 Scientific Sessions.

"Surprisingly," the impact of long-term hypertension on the risk of death from CVD has not been well studied, he observed to heart wire from Medscape. The message for clinicians is that "it really makes a difference, not just that you have hypertension, but the age at which you get hypertension," he said.

This is especially important since several studies have reported that some younger individuals with early-onset hypertension may be less likely than older individuals to receive aggressive blood-pressure management in clinical practice.

"Our results underscore the need for appropriate care in these at-risk individuals and potentially more active antihypertensive therapy," rather than using a wait-and-see approach, Niiranen and colleagues conclude.

Dr Kyong Park (Yeungnam University, Gyeongsan, South Korea), not connected with the study, asked Niiranen what specific lifestyle or antihypertensive therapy interventions they would recommend to treat young patients who already have hypertension and are at high risk of death from CVD.

Niiranen replied that this was beyond the scope of this study, but the findings highlight the importance of making sure that these patients achieve adequately controlled blood pressure, by whatever necessary means, starting with lifestyle measures, as the guidelines recommend.

"Further research is warranted to determine whether hypertension-onset age could be used to both estimate cardiovascular risk with more precision and guide therapy," the researchers conclude.

"Surprisingly" Little Study of Early-Onset Hypertension

Hypertension at any age is a well-known risk factor for CVD. However, little research has focused on outcomes of patients who develop hypertension at age 40 vs age 80, Niiranan told heartwire .

For the current study, the group analyzed data from the Framingham Heart Study of 5209 adults who were 30 to 62 years old when they were enrolled in 1948 and were then followed for 6 decades.

These participants "were studied exceptionally well," which allowed the researchers to more accurately pinpoint the onset of hypertension compared with other studies that used self-reported hypertension, Niiranen observed.

Hypertension was defined as a blood-pressure reading of ≥140/90 mm Hg or use of antihypertensive medication on two or more consecutively attended examinations.

The researchers divided the patients into five groups depending on the age of onset or absence of hypertension (<45, 45–54, 55 to 64, >65, or no hypertension).

During follow-up, 1151 patients died from CVD at a mean age of 77, and 26% of these patients had had early-onset hypertension. The patients who died from CVD included 630 patients who died from coronary disease; this subset of patients had a mean age of 74, and 29% of these patients had early-onset hypertension.

The remaining 2463 patients died from causes other than CVD, at a mean age of 81, and 16% of these patients had early-onset hypertension.

The odds of CVD death or CHD death increased linearly with decreasing age of hypertension onset.

After adjustment for age at death, sex, smoking status, total cholesterol, and diabetes, compared with individuals who did not have hypertension, those with early-onset hypertension had a 2.2-fold increased risk of dying from CVD and a 2.3-fold increased risk of dying from CHD rather than from other causes, whereas those with late-onset hypertension had a 1.5-fold increased risk of dying from CVD and a 1.4-fold increased risk of dying from CHD (P≤.002 for differences between hypertension onset at age <45 and ≥65).

The researchers previously reported that patients who had parents with early-onset hypertension had a higher risk of developing hypertension themselves.

Thus, "our results suggest that for heritability and cardiovascular risk, early-onset hypertension is a different thing from late-onset hypertension," and clinicians need to pay more attention to this young group of patients who are less likely to receive aggressive antihypertensive treatment than older patients, Niiranen said.

The authors have no relevant financial relationships.

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