Excess Dangers of High Blood Pressure Biggest With Younger Age at Start

The earlier in life that high blood pressure starts, the greater the threat for later heart disease (CVD) and death, a big Chinese research study recommends.

Scientists discovered that people age 45 years or more youthful at the time of high blood pressure start had more than two times the adjusted threats for CVD and all-cause death after a typical follow-up of 6.5 years.

Of unique note, the threats slowly decreased with each years boost in the age of high blood pressure start amongst both neglected and cured clients, the authors reported today today in the Journal of the American College of Cardiology.

“Our research study recommended that the factor to consider of high blood pressure start age would offer unique and preventive details beyond standard cardiovascular threat evaluation systems,” senior author Hao Xue, MD, Chinese PLA General Health Center, Beijing, informed theheart.org | Medscape Cardiology by e-mail.

“It likewise highlights the requirement to consist of age at high blood pressure medical diagnosis in cardioprotective standards and policies,” he stated.

The age of high blood pressure start is under increasing analysis, consisting of current reports connecting early start with cardiovascular death in midlife in the Framingham Heart Research study and with hypertensive end-organ damage in the CARDIA research study.

These research studies, nevertheless, did not analyze all-cause death and were carried out in mainly white populations. So the brand-new findings in a big Asian population aid fill a research study space, the authors observe.

“For numerous, this is an affirmation that high blood pressure in the young is essential to recognize and step in,” stated Daniel W. Jones, MD, teacher of medication and physiology, University of Mississippi Medical Center, Jackson, informed theheart.org | Medscape Cardiology. “Clients and service providers require to focus on this.”

The frequency of high blood pressure is increasing internationally, and since of irregular contact with the health system, numerous young people, especially males, frequently go undiagnosed and neglected, he kept in mind.

Even more, the excess CVD threats observed in the research study would likely have actually been higher if high blood pressure had actually been specified by the more rigid United States high blood pressure (BP) limit of 130/80 mm Hg.

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“The threat from high blood pressure starts long prior to the meaning of high blood pressure,” Jones stated. “It starts at about 115 (mm Hg) systolic high blood pressure.”

In late 2017, the American Heart Association, American College of Cardiology, and 9 other health companies redefined high blood pressure, reducing the target from 140/90 mm Hg to 130/80 mm Hg for all grownups.

The 2018 European standards suggest drug treatment to a systolic BP target less than 140 mm Hg for the majority of clients and to less than 130 mm Hg for clients more youthful than 65 years who can endure it.

The present research study covers an earlier duration and includes 71,245 individuals in the potential Kailuan research study who were devoid of high blood pressure and CVD in the very first study (2006 to 2007) and were followed biennially up until their death or December 2017.

New-onset high blood pressure, specified by either high blood pressure of a minimum of 140/90 mm Hg or using an antihypertensive medication on 2 or more successive sees, was determined in 20,221 individuals throughout follow-up.

Cases were divided into 4 groups based upon age at start (<45 years, 45-54 years, 55-64 years, ≥65 years) and had an average age of 38.7 years, 50.5 years, 59.4 years, and 71.6 years, respectively. In all, 38% reported antihypertensive medication use.

Ultimately, 19,887 pairs of case and age- and sex-matched normotensive participants were included in the analysis. Cases were more likely to be ever-smokers and ever-drinkers, and to have a higher body mass index, heart rate, fasting blood glucose, triglycerides, total cholesterol, and estimated glomerular filtration rate.

During follow-up, there were 1672 incident CVD cases and 2008 deaths.

After multivariate adjustment, the risks of CVD and all-cause mortality were highest for individuals with hypertension onset before age 45 years.

Table. CVD, All-Cause Mortality by Hypertension Onset Age

 Average Hazard

95% Confidence

Cardiovascular Disease

(P for interaction = .38)
<45 yrs2.261.19 – 4.30
45-54 yrs1.621.24 – 2.12
55-64 yrs1.421.12 – 1.79
≥65 yrs1.331.04 – 1.69
All-cause Mortality (P for interaction <.01)
<45 yrs2.591.32 – 5.07
45-54 yrs2.121.55 – 2.90
55-64 yrs1.301.03 – 1.62
≥65 yrs1.291.11 –  1.51
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Similar patterns were observed for stroke in CVD subtype analyses, and in several sensitivity analyses.

In further analysis, the median systolic BP of the treated group was significantly higher than the untreated group (147 mm Hg vs 141 mm Hg; P <.01).

“The treated population did not show a better blood pressure control in our study,” Xue said. “This may reflect an indication bias that patients with more severe symptoms (in this case, higher blood pressure) would be more likely to be treated. Therefore, the higher blood pressure in treated groups may result in the same risk pattern as the untreated group.”

He also noted that a national survey found that just 9% of young people in China had hypertension but that rates of hypertension awareness, treatment, and control were significantly lower in younger patients than older generations.

“Large-scale randomized controlled trials are still warranted to determine ideal target BP levels among young hypertensive patients,” Xue said. “In addition, more aggressive efforts are needed to develop management strategies that sustain long-term blood pressure control.”

In China, several hospitals have already taken some measures to improve hypertension awareness by installing electronic sphygmomanometers in public places, including airports and markets, he said. “It would cover more high-risk populations of hypertension and attract people to pay more attention on their blood pressure conditions.”

Jones said their team is using social media to obtain informed consent from patients identified with elevated BP in one of their clinics and then mailing them a pad and BP monitor to measure BP at regular intervals. Patients then interact on social media with nurse practitioners, who can prescribe and adjust medications.

In an accompanying editorial, Teemu J. Niiranen, MD, University of Turku, Finland, and colleagues said that the present study provides additional “compelling evidence” on the adverse effects of early-onset hypertension.

“The implications of this work are potentially far-reaching,” they write. “The authors correctly speculate that assessment of hypertension-onset age could improve overall CVD risk stratification, and that individuals with early-onset hypertension might benefit from more intensive hypertension treatment, including lifestyle interventions and antihypertensive therapy.”

The editorialists note that parental age of hypertension also may be useful for estimating risk in offspring, and that their own research suggests self-report could improve the feasibility of incorporating hypertension-age onset assessment into clinical practice.

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Although younger patients tend to overlook the health hazards of hypertension, current guidelines do not recommend using age of hypertension onset as part of a CVD risk assessment. Contemporary recommendations also do not yet emphasize the importance of adequate therapy in young patients, Niiranen and colleagues point out.

“Future guideline iterations could include revisions that specify treatment approaches for patients with early-onset hypertension, given their considerable greater lifetime CVD risk when compared with patients with late-onset hypertension,” they conclude.

Jones and the editorialists have disclosed no relevant financial relationships.

J Am Coll Cardiol. Published online June 8, 2020. Abstract, Editorial

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