Arterial hypertension before age 40 due to previous strokes, heart disease

People who develop high blood pressure before age 40 have a higher risk of heart disease and stroke in middle age, suggesting two new studies.

One of the studies followed 4,800 young adults in the United States and detected a 'high blood pressure before age 40, associated with a risk up to 3.5 times greater than heart disease and stroke in about 19 years of follow-up .

The second study looked at data on nearly 2.5 million young adults in South Korea for over a decade and also found high blood pressure before the age of 40 was linked to an increased risk of heart disease and stroke.

The women in this study had up to 76% more risk of cardiovascular disease, while for men the risk was 85% higher, compared to peers with normal blood pressure.

"The increase in blood pressure in early adulthood can lead to heart attacks with different mechanisms, and these levels of blood pressure can progress to higher levels over time," said Ramachandran S. Vasan of medical schools and public health of the University of Boston.

"They are often associated with … other risk factors (such as excess weight, high cholesterol, high blood sugar and smoking) that synergistically elevate heart attack and stroke risk," said Vasan, author of an accompanying editorial.

"They can promote damage to target organs including the heart and arteries, thickening of the arterial walls and accumulation of cholesterol deposits / plaques in the arteries, thus creating a substrate (" soil ", if desired) for future heart attacks and strokes" .

For studies, both published on JAMA, researchers evaluated hypertension using new, more aggressive targets recommended by the American Heart Association and the American College of Cardiology in 2017.

The new recommendations were based on emerging evidence suggesting that even a slightly elevated blood pressure at the start of life could be a precursor of cardiovascular disease with an aging population.

Patients were classified as hypertensive when the "upper number" or systolic pressure (which reflects the pressure against the walls of the arteries when the heart beats), on average at least 130 mmHG (millimeters of mercury).

They were also considered hypertensive if the "lower number" or the diastolic pressure (which reflects the pressure against the walls of the arteries when the heart rests between the beats), on average at least 80 mmHG.

Before the new recommendations in 2017, people were not diagnosed with high blood pressure until they had measurements of 140/90 mmHG or higher.

Not all doctors treated patients using the new, more aggressive blood pressure target, partly because of the concern that long-term use of drugs to lower blood pressure could have side effects, such as diarrhea or constipation, dizziness, fatigue, headache, nausea or vomiting or mood disorders.

While young adults with hypertension should consider the potential side effects of medications, they may be able to manage their blood pressure with lifestyle changes such as eating better or doing more exercise and should discuss these options with their doctor, he said the senior author of the Korean Studio, Dr. Sang Min Park of the National Hospital of the University of Seoul.

"We have shown that hypertension, even at a young age, may be associated with a greater risk of heart attacks or strokes," Park said by email. "Therefore, young adults with hypertension should have their blood pressure monitored on a regular basis and manage their blood pressure levels with lifestyle changes or medications."

Lifestyle changes are not only helpful in reducing blood pressure and the risk of cardiovascular disease, but may also lead to improved physical and mental health, Park said.

No study has examined whether aggressive treatment of blood pressure could prevent people from developing heart disease or dying.

But the results still suggest that more aggressive treatment of blood pressure at a young age could help minimize the risk of premature heart problems later in life, said lead author of the American study Dr. Yuichiro Yano of Duke University of Durham, North Carolina.

"Our study is among the first to report that people under the age of 40 who have high blood pressure or hypertension are at increased risk for heart failure, stroke and blood vessel blockages as they age," Yano said via e- email.


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