Blood Pressure in Early Adulthood, Hypertension in Middle Age, and Future Cardiovascular Disease Mortality

Abstract

Objectives To examine the association of early adulthood blood pressure with CVD mortality, while accounting for middle-age hypertension. Background Elevated blood pressure in middle-age is an established CVD risk factor, but evidence for association with measurements earlier in life is sparse. Methods HAHS is a cohort study of 18,881 male university students who had blood pressure measured at university entry (1914 –1952; mean age 18.3 years) and who responded to a questionnaire mailed in 1962/1966 (mean age 45.8 years) in which physician-diagnosed hypertension status was reported. Study members were subsequently followed for mortality until the end of 1998. Results Following adjustment for age, BMI, smoking and physical activity at college entry, compared to men who were normotensive according to JNC-7 criteria (<120/<80mmHg) there was an elevated risk of CHD mortality (1,917 deaths) in those who were pre-hypertensive (120–139/80–89 mmHg) (hazards ratio; 95% confidence intervals: 1.21; 1.07, 1.36), stage 1 (140–159/90–99 mmHg) (1.46; 1.25, 1.70), and stage 2 hypertensive (≥160/≥100 mmHg) (1.89; 1.46, 2.45), incremental across categories (ptrend<0.001). After additional account for middle-age hypertension, estimates were somewhat attenuated but the pattern remained. Similar associations were apparent for total and CVD but not stroke mortality. Conclusions Higher blood pressure in early adulthood was associated with elevated risk of mortality from all-causes, CVD and CHD, but not stroke several decades later. Effects largely persisted after taking account of mediation by middle-age hypertension. Thus, the long-term benefits of blood pressure lowering in early adulthood are promising but supporting trial data are required.

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

“…Although many reports describe the association of hypertension with increased cardiovascular mortality,2, 4, 14, 40, 41, 42, 43 this unique data set links small increases in BP and cholesterol at midlife with UMI and RMI evaluated by CMR on average 31 years later.…”

American‐Style Football and Cardiovascular Health

“…In the prospective Harvard Alumni Health Study of 18 881 male undergraduate participants, cardiovascular disease mortality was significantly associated with the participants’ blood pressure as recorded at the time of university matriculation 9. Importantly, the risk estimates remained relatively unchanged after adjustment for the presence of middle‐aged hypertension.…”

“…Among nonathletic cohorts, the prognostic implications of cardiovascular risk factors emerging early in life including obesity,26 hypertension,9, 10 impaired glucose handling,27 dyslipidemia,28 and arterial stiffness29 have been well established. Although comparable outcomes data among ASF participants are lacking, a growing body of literature describes analogous and, in some cases, more unfavorable cardiovascular risk factor profiles among similarly aged ASF athletes (Table 1).…”

“…Factors including high loads of static hemodynamic stress, relatively low amounts of aerobic conditioning, deliberate body mass gain, psychological stress, and routine NSAID8 use carry potential implications for cardiovascular health. In healthy nonathletic populations, early onset cardiovascular risk and attendant subclinical pathology at ages typical of ASF athletes predict later life cardiovascular morbidity and mortality 9, 10, 11. Although this phenomenon has not been firmly established among ASF participants, a growing body of observational data documents associations among large body mass,12, 13 early life hypertension,12, 14 and subclinical pathologic cardiovascular phenotypes15, 16, 17, 18 in ASF athletes.…”

Reply to ‘What leads to healthy ageing and longevity?’

“…However, hypertension, an important predictor of mortality in adulthood, was not taken into account (2) . In recent research, higher blood pressure in early adulthood was associated with elevated risk of all-cause mortality and other chronic diseases (3) . In this context, therefore, not adjusting for hypertension could bias the observed effect.…”