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People who develop high blood pressure before age 40 have a higher risk of heart disease and stroke in middle age, two new studies show.
One study followed 4,800 young adults in the United States and found high blood pressure before age 40 was associated with a 3½ times greater risk of heart disease and stroke for about 19 years of follow-up.
The second study examined data on nearly 2.5 million young adults in South Korea for a decade and also found that high blood pressure before age 40 was associated with a greater risk of heart disease and stroke. Women in this study had a 76 percent higher risk of cardiovascular disease, while for men the risk was 85 percent higher, compared to peers with normal blood pressure.
"Increased blood pressure in early adulthood can lead to heart attacks by several mechanisms, and this blood pressure level can develop to a higher level over time," said Ramachandran Vasan of Boston University School of Medicine and the School of Public Health.
High blood pressure is often associated with other risk factors, such as being overweight, high cholesterol, high blood sugar and smoking, which increases the risk of strokes and heart attacks, Vasan, the accompanying editorial author, said via email. This can damage target organs, including the heart and arteries, and increase thickening of the arterial wall and buildup of cholesterol deposits and plaques in the arteries, "thus creating a substrate (" soil, "if you want) for future heart attacks and strokes."
For the study, both published on Tuesday in the Journal of the American Medical Association, researchers assessed high blood pressure using a new, more aggressive target level recommended by the American Heart Association and the American College of Cardiology in 2017. This new recommendation is based on the emergence of evidence that shows that blood pressure that is slightly higher early in life may be a precursor to cardiovascular disease as we age.
Patients are classified as having hypertension when the amount of reading is above them, or systolic pressure (reflecting pressure on the arterial wall when the heart is beating), averaging at least 130 millimeters of mercury.
They are also considered to have hypertension if the lower number, or diastolic pressure (reflects pressure on the arterial wall when the heart is in between beats), averaging at least 80 millimeters of mercury.
Before new recommendations in 2017, people were not diagnosed with high blood pressure until they were 140/90 or higher.
Not all doctors have treated patients using new and more aggressive blood pressure targets, partly because they are concerned that long-term use of drugs to lower blood pressure may have side effects, such as diarrhea or constipation, dizziness, fatigue, headaches, nausea or vomiting or disorders mood.
While young adults with high blood pressure must consider the potential side effects of drugs, they may be able to manage their blood pressure with lifestyle changes such as eating better or exercising more, and they should discuss this option with their doctors, said the senior Korean research writer , Dr. Sang-min Park at Seoul National University Hospital.
"We have shown that hypertension even at a young age can be associated with a high risk of heart attack or stroke," Park said via email. "Therefore, young adults with hypertension must have their blood pressure monitored regularly and manage their blood pressure levels with lifestyle changes or medication."
Lifestyle changes are beneficial not only to reduce blood pressure and the risk of cardiovascular disease, but also can improve physical and mental health, Park noted.
No study has looked at whether aggressive blood pressure therapy can stop people from developing heart disease or die from it.
But the results still show that treating blood pressure more aggressively at a younger age might help minimize the risk of future premature heart problems, said the US-based lead author, Dr. Yuichiro Yano from Duke University.
"Our study is the first to report that people younger than 40 who have increased blood pressure or hypertension are at an increased risk of heart failure, stroke and blood vessel blockage as they get older," Yano said via email.