Sudden Blood Pressure Elevations in Youth Lead to Elevated Cardiovascular Disease Risk on Older Age

Spikes in blood pressure early in life are associated with increased risk for cardiovascular disease later in life, a new study in JAMA Cardiology reports.

“If a patient comes in with one reading in December and a significantly lower reading in January, the average might be within the range that would appear normal,” lead author Yuichiro Yano, MD, PhD, assistant professor in Duke’s Department of Family Medicine and Community Health, said in a press release. “Is that difference associated with health outcomes in later life?” Yano said. “That’s the question we sought to answer in this study, and it turns out the answer is yes.”

The study included 3,394 black and white individuals from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The researchers looked at patterns of systolic blood pressure (with measurements at baseline) at year zero, and at ten years. Data collection ran from 1985 through 2015. The main study outcome was cardiovascular disease and all-cause mortality occurring through 2015.

Mean age of the participants at ten years was 35.1 (45.9% African American, 55.7% women). There was a median follow-up of 20.0 years (interquartile range, 19.4 to 20.2). The authors reported 162 cardiovascular disease events and 181 deaths in the study population. For each spike of 3.6 mm Hg in systolic blood pressure during young adulthood was linked with a 15% increase in heart disease events. This relationship was independent of average blood pressure measurements during adulthood and any single measurement during midlife. Hazard ratios for cardiovascular disease events for each 1-standard deviation increase in systolic blood pressure measures were 1.25 (95% CI, 0.90 to 1.74) for mean systolic blood pressure, 1.23 (95% CI, 1.07 to 1.43) for variability independent of the mean systolic blood pressure, and 0.99 (95% CI, 0.81 to 1.26) for annual systolic blood pressure change.

“Current guidelines defining hypertension and assessing the need for anti-hypertensive therapies ignore variability in blood pressure readings,” Dr. Yano said. “I think there has been a belief that variability is a chance phenomenon, but this research indicates maybe not. Variability matters.”