Author Insights: Upward Trend for Blood Pressure in Young Adults Predicts Long-term Heart Risk

Norrina B. Allen, PhD, MPH, of Northwestern’s Feinberg School of Medicine, and colleagues found that blood pressure patterns early in life predict heart risk. Image: Northwestern University

Norrina B. Allen, PhD, MPH, of Northwestern’s Feinberg School of Medicine, and colleagues found that blood pressure patterns early in life predict heart risk. Image: Northwestern University

Blood pressure trajectories during young adulthood may help identify those at greatest risk of cardiovascular disease later in life, according to a study published in JAMA today.

A single high blood pressure reading is a known risk factor for developing the hardening of the arteries associated with an elevated risk of heart attack or strokes. But often high blood pressure doesn’t emerge until middle life, when this process may already be under way.

The new study suggests that blood pressure trends earlier in life may help identify those at highest risk, allowing earlier intervention. Norrina B. Allen, PhD, MPH, associate professor in the department of preventive medicine at Northwestern’s Feinberg School of Medicine, and her colleagues analyzed data on 4681 participants from the CARDIA study. Health information including blood pressure readings and other health data were collected from participants over the course of 25 years from 1985-1986 through 2010-2011.

They found that young people typically experienced 1 of 5 long-term blood pressure trajectories and that an individual’s risk of developing hardening of the arteries varied by trajectory. Those with blood pressure readings classified as being in the prehypertension range and those with trends of increasing blood pressure readings over time were at higher risk of artery hardening than patients with low and stable blood pressure readings.

Dr Allen discussed the findings with news@JAMA.

news@JAMA: Why did you decide to conduct this analysis?

Dr Allen: We were interested in whether long-term patterns in blood pressure could be used to predict cardiovascular disease risk.

news@JAMA: What did you learn about the predictive value of these blood pressure trends?

Dr Allen: We found that there are 5 distinct blood pressure trajectories and that these 25-year patterns were associated with coronary artery calcification, a marker of cardiac risk.

news@JAMA: Where there any groups in particular who were more likely to fall in a higher-risk trajectory?

Dr Allen: We did find that African Americans and those who smoked or gained weight more quickly were more likely to fall into a higher trajectory pattern.

news@JAMA: Did the long-term trends better predict cardiac risk than 1-time readings?

Dr Allen: We are better able to stratify individuals by their risk for cardiovascular disease. So if you had 2 people who end up with an elevated blood pressure in middle age, one who had ideal blood pressure in young adulthood and one with elevated blood pressure for the entire 25-year period, the one with elevated blood pressure the whole time had a higher risk for cardiovascular disease.

For almost all of the groups, the levels of elevated blood pressure didn’t meet clinical thresholds for hypertension but were above ideal levels. We would recommend lifestyle changes for individuals with elevated blood pressure levels or increasing blood pressure readings early in life.

news@JAMA: Do your findings suggest changes in the way hypertension is currently being treated?

Dr Allen: It’s more a matter of when we start considering markers of heart disease risk. It’s really about prevention. We really should monitor earlier.

news@JAMA: What is the main take-home message for patients and physicians?

Dr Allen: The message is to start thinking about blood pressure and its associated risks early in life and really consider ways to prevent elevated blood pressure or increasing blood pressure before people hit middle age. Individuals experiencing either are at a higher risk for heart disease later in life.



Categories: Cardiovascular Disease/Myocardial Infarction, Hypertension, Primary Care/Family Medicine, Stroke, Uncategorized

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