Researchers in China evaluated the future cardiovascular risk of high blood pressure in young people.
High blood pressure is a well-recognized risk factor for cardiovascular problems such as heart attack or stroke in later life. Reducing raised blood pressure through healthy lifestyle improvements (such as increasing exercise, losing weight or stopping smoking) and antihypertensive medication as necessary, has been shown to lower the risk of cardiovascular disease. However, most studies investigating high blood pressure have focused on older adults. Recent reports show that the prevalence of high blood pressure in young people is rising and more information is needed on the cardiovascular risks for this group. Researchers in China performed a combined analysis of studies looking at the risk of cardiovascular events in younger adults with raised blood pressure. They recently published their findings in the BMJ.
Prevalence of high blood pressure in young people is rising
The researchers analyzed data from 17 observational studies investigating the risk of cardiovascular events in adults aged between 18-45 years at different blood pressure levels. The studies included a total of 4.5 million young adults, followed for an average of 15 years. The researchers split the data into five blood pressure groups, according to 2018 European Guidelines: optimal (<120/80mm Hg), normal 120-129/80-84mmHg, high normal (130-139/85-89 mmHg), grade 1 hypertension (140-159/90-99mmHg), and grade 2 hypertension (≥160/100 mmHg). They compared the risk of cardiovascular events in the optimal blood pressure group with each of the other groups.
The data analysis showed a graded, progressive association between increasing blood pressure groups and risk of all cardiovascular events. In the optimal blood pressure group the rate of cardiovascular events was estimated to be 1.97 per 1,000 person years. Compared with the optimal group, there was a 19% increased risk in the normal group and a 35% increased risk in the high normal group. The risk almost doubled in the grade 1 hypertension group, and was more than three times in the grade 2 hypertension group. A similar pattern of risk was observed when looking at coronary heart disease and stroke separately.
On the other hand, the absolute risk of cardiovascular events in all groups was relatively low. Based on the findings, the number of individuals needed to treat for one year to prevent one cardiovascular event would be: 2,672 in the normal pressure group, 1,450 in the high blood pressure group, 552 in the grade 1 hypertension group, and 236 in the grade 2 hypertension group.
High blood pressure in young people may slightly increase risk of heart problems
The researchers concluded that young adults with raised blood pressure might have a slightly increased risk of heart problems or stroke in later life. However, they stress that the absolute risk is low and more research is needed before suggesting any medical intervention. “Because the evidence for blood pressure lowering is limited, active interventions should be cautious and warrant further investigation,” say the study authors.
Written by Julie McShane, MA MB BS
1. Luo DL, Cheng YJ, Zhang HF, et al. Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ 2020; 370:m3222
2. BMJ, Press release 9 Sep 2020. Young adults with raised blood pressure may have increased risk of later heart problems. https://www.eurekalert.org/pub_releases/2020-09/b-yaw090820.php
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