Editorials

High blood pressure in young people and premature death

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1104 (Published 22 February 2011) Cite this as: BMJ 2011;342:d1104
  1. Bryan Williams, professor of medicine
  1. 1Department of Cardiovascular Sciences and the Leicester NIHR Cardiovascular Biomedical Research Unit in Cardiovascular Diseases, University of Leicester, Leicester LE3 9QP, UK
  1. bw17{at}le.ac.uk

Alternative strategies are needed to stratify risk and determine treatment thresholds

In the linked cohort study (doi:10.1136/bmj.d643), Sundström and colleagues followed more than 1.2 million young Swedish army conscripts over a 37 year period to assess the relation between blood pressure in late adolescence and subsequent cardiovascular mortality and total mortality.1

RIA/Alamy

Blood pressure values track from childhood, indicating a slow process of disease evolution—a process that is now accelerated by the rise in childhood obesity. The clinical dilemma is when to intervene with lifestyle interventions and treatment.2 The problem with guidelines is that they are based on evidence from clinical trials with hard clinical end points such as coronary heart disease, stroke events, or death. Such events occur mainly in older people, so younger people with high blood pressure are largely excluded from the trials.

Furthermore, using cardiovascular risk assessment to stratify younger people for treatment is problematic because young people are at low short term risk and are thus unlikely to reach the required risk threshold for treatment. The decision about what to do with younger people with high blood pressure has also been compounded by a lack of data about the relation between blood pressure in the young and the subsequent risk of death.

The challenge to acquire such …

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