High Blood Pressure in Young Adulthood and Risk of Premature Cardiovascular Disease

Vasan, Ramachandran S.

doi:10.1001/jama.2018.16068

Cited by 21 publications

(16 citation statements)

References 22 publications

(33 reference statements)

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“…White coat hypertension, a hyperadrenergic state, a higher prevalence of secondary hypertension, and hypertension caused by peripheral blood pressure amplification are more commonly seen in young adults. Conversely, loss of arterial compliance and increased arterial stiffness are often found in older people, concurrent with increasing systolic blood pressure and decreasing diastolic blood pressure 55051. Understanding such pathophysiological links among different age groups could help us to better understand what we found in this study.…”

Section: Discussionmentioning

confidence: 62%

“…Conversely, loss of arterial compliance and increased arterial stiffness are often found in older people, concurrent with increasing systolic blood pressure and decreasing diastolic blood pressure. 5 50 51 Understanding such pathophysiological links among different age groups could help us to better understand what we found in this study. The Monica, Risk, Genetics, Archiving and Monograph project, a large population based cohort, found a gradual age related shift from diastolic blood pressure to both diastolic blood pressure and systolic blood pressure, and eventually to systolic blood pressure as a risk factor for cardiovascular events.…”

Section: Discussionmentioning

confidence: 80%

“…Systolic and diastolic blood pressure each independently influenced cardiovascular outcomes in young adults. The pathophysiological basis of high blood pressure in young adults and older people seems to be different 550. White coat hypertension, a hyperadrenergic state, a higher prevalence of secondary hypertension, and hypertension caused by peripheral blood pressure amplification are more commonly seen in young adults.…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiological basis of high blood pressure in young adults and older people seems to be different. 5 50 White coat hypertension, a hyperadrenergic state, a higher prevalence of secondary hypertension, and hypertension caused by peripheral blood pressure amplification are more commonly seen in young adults. Conversely, loss of arterial compliance and increased arterial stiffness are often found in older people, concurrent with increasing systolic blood pressure and decreasing diastolic blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Luo

Cheng

Zhang

et al. 2020

BMJ

121

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ObjectiveTo evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, and Web of Science were searched from inception to 6 March 2020. Relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Absolute risk difference was calculated. Dose-response relations between blood pressure and individual outcomes were assessed by a restricted cubic spline model.Eligibility criteria for selecting studiesStudies were selected that investigated the adverse outcomes of adults aged 18-45 with raised blood pressure. The primary study outcome was a composite of total cardiovascular events. Coronary heart disease, stroke, and all cause mortality were examined as secondary outcomes.ResultsSeventeen observational cohorts consisting of approximately 4.5 million young adults were included in the analysis. The average follow-up was 14.7 years. Young adults with normal blood pressure had increased risk of cardiovascular events compared with those with optimal blood pressure (relative risk 1.19, 95% confidence interval 1.08 to 1.31; risk difference 0.37, 95% confidence interval 0.16 to 0.61 per 1000 person years). A graded, progressive association was found between blood pressure categories and increased risk of cardiovascular events (high normal blood pressure: relative risk 1.35, 95% confidence interval 1.22 to 1.49; risk difference 0.69, 95% confidence interval 0.43 to 0.97 per 1000 person years; grade 1 hypertension: 1.92, 1.68 to 2.19; 1.81, 1.34 to 2.34; grade 2 hypertension: 3.15, 2.31 to 4.29; 4.24, 2.58 to 6.48). Similar results were observed for coronary heart disease and stroke. Generally, the population attributable fraction for cardiovascular events associated with raised blood pressure was 23.8% (95% confidence interval 17.9% to 28.8%). The number needed to treat for one year to prevent one cardiovascular event was estimated at 2672 (95% confidence interval 1639 to 6250) for participants with normal blood pressure, 1450 (1031 to 2326) for those with high normal blood pressure, 552 (427 to 746) for those with grade 1 hypertension, and 236 (154 to 388) for those with grade 2 hypertension.ConclusionsYoung adults with raised blood pressure might have a slightly increased risk of cardiovascular events in later life. Because the evidence for blood pressure lowering is limited, active interventions should be cautious and warrant further investigation.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Luo

Cheng

Zhang

et al. 2020

BMJ

121

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“…Hypertension is a significant health threat and an independent predictor of CV events including coronary heart disease, stroke, heart failure, and dementia in the general population [1] and in RA [2]. The prevalence of hypertension in rheumatoid arthritis (RA) is high, but varies between 4 and 72% producing inconsistent results in the repeated meta-analysis [3–5].…”

Section: Introductionmentioning

confidence: 99%

Low serum IGF1 is associated with hypertension and predicts early cardiovascular events in women with rheumatoid arthritis

Erlandsson

Lyngfelt

Åberg

et al. 2019

BMC Med

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Objectives Since low insulin-like growth factor (IGF) 1 is often linked to inflammation, we analyze whether serum levels of IGF1 are associated with cardiovascular disease (CVD) in rheumatoid arthritis (RA) in a longitudinal observational study. Methods A CVD risk was estimated (eCVR) in 184 female RA patients (mean age 52 years) and in 132 female patients after ischemic stroke (mean age 56 years) with no rheumatic disease, using the Framingham algorithm. The median level of IGF1 divided the cohorts in IGF1 high and IGF1 low groups. A 5-year prospective follow-up for new CVD events was completed in all RA patients. The Mantel-Cox analysis and event-free survival curves were prepared. Unsupervised clustering of proteins within the IGF1 signaling pathway was employed to identify their association with eCVR. Results Low IGF1 resulted in a higher eCVR in RA patients (7.2% and 3.3%, p = 0.0063) and in stroke (9.3% and 7.1%, p = 0.033). RA had higher rate for new CVD events at prospective follow-up (OR 4.96, p = 0.028). Hypertension was the major risk factor associated with low IGF1 in RA and stroke. In hypertension, IGF1 was no longer responsible for intracellular activation and lost its correlation to IRS1/2 adaptor proteins. The clustering analysis confirmed that combination of low IGF1 and IRS1/2 with high IL6, insulin, and glucose predisposed to high eCVR and emphasized the functional role of serum IGF1. Conclusions Low serum IGF1 precedes and predicts development of early CVD events in female RA patients. Hypertension and aberrant IGF1 receptor signaling are highlighted as the important contributors to IGF1-related CVD events.

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Hypertension—A Public Health Challenge of Global Proportions

Fisher

Curfman²

2018

JAMA

120

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This issue of JAMA, from illustrated cover to in-depth content, is dedicated to hypertension, a worldwide problem of enormous consequence. High blood pressure affects more than 1 billion people worldwide, and that number is increasing. Untreated or uncontrolled, hypertension is the single largest contributor to cardiovascular disease, causing stroke, heart failure, coronary artery disease, and kidney disease, and also is a major contributor to kidney disease. Progress over the last several decades has led to increased understanding of the relationship between blood pressure and health outcomes and to the development of multiple antihypertensive therapies that reduce the risk. New knowledge carries with it a mandate to address the growing global epidemic of hypertension.Hypertension continues to be the major risk factor for cardiovascular death in every region of the world. Even more striking, in 2010 high blood pressure emerged as the leading single risk factor for the overall global burden of disease, surpassing diseases like diarrheal illness and pneumonia. 1 Systolic blood pressure exceeding 140 mm Hg was estimated to be responsible for 14% of total deaths in 2015. 2 Yet it is now clear that cardiovascular risk begins at pressures much lower than 140 mm Hg. When considering individuals with systolic blood pressure of at least 110 to 115 mm Hg, regarded as the theoretical minimum risk level for blood pressure, an estimated 3.5 billion people are affected. 2 Of all individual risk factors quantified in the global burden of disease study of 2015, a systolic blood pressure of at least 110 to 115 mm Hg was the leading contributor to preventable death in the world. 2 The rising prevalence of high blood pressure dominates the worldwide shift away from risks for communicable diseases in children toward those for noncommunicable diseases in adults. It parallels another disturbing trend: the transition of the burden of hypertension to countries with poorly developed health care systems, as described by Qamar and Braunwald in this issue. 3 From 1975 to 2015, mean blood pressure decreased in high-income western and Asia Pacific countries, yet increased in East and Southeast Asia, South Asia, Oceania, and sub-Saharan Africa. 4 In addition to population growth and aging of populations, multiple factors contribute to the increasing numbers of people with hypertension. Many of these result from the urbanization of societies and the detrimental changes in lifestyle that often follow: westernized di-

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High Blood Pressure in Young Adulthood and Risk of Premature Cardiovascular Disease

Cited by 21 publications

References 22 publications

Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

Low serum IGF1 is associated with hypertension and predicts early cardiovascular events in women with rheumatoid arthritis

Hypertension—A Public Health Challenge of Global Proportions

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