Chronic exposure to higher BP in young adults is associated with cardiac dysfunction in middle ageBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3384 (Published 23 June 2015) Cite this as: BMJ 2015;350:h3384
Young adults with blood pressure at the higher end of the normal range that continues into middle age have a raised risk of left ventricular dysfunction, says a 25 year follow-up study published in the Journal of the American College of Cardiology, which suggests recommending lifestyle changes in younger people to reduce elevated blood pressure.
The Coronary Artery Risk Development in Young Adults (CARDIA) study followed up 2479 men and women aged 18 to 30 at baseline in 1985 and 1986.1 Researchers assessed participants’ health, including measuring their blood pressure, on seven occasions during the 25 years of the study and used cardiac imaging to check their heart function on the final visit. They calculated the participants’ cumulative exposure to blood pressure from baseline to the 25 year examination (mm Hg x year) to assess long term exposure to blood pressure.
Results showed that cumulative exposure to blood pressure was independently associated with diastolic dysfunction, particularly in people with raised diastolic blood pressure (odds ratio 1.69 (95% confidence interval 1.23 to 2.33)). Systolic dysfunction also increased with higher cumulative exposure to blood pressure.
The researchers said the findings showed that young adults with elevated blood pressure should be advised to reduce their sodium intake, maintain a healthy body weight, and keep physically active to reduce their blood pressure.
“Our findings provide further support for the importance of good risk factor control early in life,” said Joao Lima, lead author from the division of cardiology at Johns Hopkins University School of Medicine in Baltimore, USA. “Many participants were not hypertensive at the beginning of the study; however, chronic exposure to higher blood pressure, even within what is considered the normal range, is associated with cardiac dysfunction 25 years later.”
The research group acknowledged that its findings were based on non-clinical endpoints and recommended further studies using clinical endpoints.
In an accompanying editorial2 Thomas Marwick, of the Menzies Institute for Medical Research at the University of Tasmania, Australia, commented, “This research raises critical questions about the importance of blood pressure even earlier in life and the need for longitudinal studies beginning in childhood or youth.” He added that identifying patients at risk at an earlier age could prevent the development of heart dysfunction and failure.
Cite this as: BMJ 2015;350:h3384