Increased BP in young adulthood could influence future CV event risk
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High BP in young adulthood may slightly increase the risk for CV events later in life, researchers found.
“In the current study, we learned that cardiovascular risk was found already increased at a level of ‘normal BP’ in young adults,” Hao Chen, MD, physician at Guangdong Provincial People’s Hospital at Guangdong Academy of Medical Sciences in Guangzhou, China, told Healio. “In addition, continuous and graded relationships between categorical BP increments and increasing risks of different cardiovascular outcomes were observed. … These findings extended our knowledge on hypertension and cardiovascular risks in young adults, which would probably help to refine strategies for primary prevention in young adults.”
Review of longitudinal cohort studies
In this systematic review and meta-analysis published in The BMJ, Dongling Luo, physician in the department of cardiology at Guangdong Cardiovascular Institute at Guangdong Provincial People’s Hospital at Guangdong Academy of Medical Sciences, and colleagues analyzed data 4,533,292 participants from 17 observational cohorts. Studies in this analysis were longitudinal cohort studies with participants aged 18 to 45 years that assessed the link between increased BP and study outcomes.
Participants were stratified by BP into five subgroups according to the 2018 European guideline: optimal BP (< 120 mm Hg systolic and < 80 mm Hg diastolic), normal BP (120-129 mm Hg systolic and 80-84 mm Hg diastolic), high BP (130-139 mm Hg systolic and 85-89 mm Hg diastolic), grade 1 hypertension (140-149 mm Hg systolic and 90-99 mm Hg diastolic) and grade 2 hypertension ( 160 mm Hg systolic and 100 mm Hg diastolic).
The primary study outcome was a composite of total CV events, including stroke, CHD, any CV deaths, HF and other types of CVDs. Secondary outcomes included stroke, CHD and all-cause mortality. Follow-up was conducted for an average of 14.7 years.
Compared with optimal BP, those with normal BP had an increased risk for CV events (RR = 1.19; 95% CI, 1.08-1.31; risk difference per 1,000 person-years = 0.37; 95% CI, 0.16-0.61). There was a graded, progressive association between BP categories and increased risk for CV events, as shown in participants with high BP (RR = 1.35; 95% CI, 1.22-1.49; risk difference per 1,000 person-years = 0.69; 95% CI, 0.43-0.97), grade 1 hypertension (RR = 1.92; 95% CI, 1.68-2.19; risk difference per 1,000 person-years = 1.81; 95% CI, 1.34-2.34) and grade 2 hypertension (RR = 3.15; 95% CI, 2.31-4.29; risk difference per 1,000 person-years = 4.24; 95% CI, 2.58-6.48).
Results were similar when stroke and CHD were assessed.
The population attributable fraction for CV events linked with increased BP was 23.8% (95% CI, 17.9-28.8).
Number needed to treat
To prevent one CV event, the number needed to treat for 1 year was 2,672 for participants with normal BP (95% CI, 1.639-6,250), 1,450 for those with high BP (95% CI, 1,031-2,326), 552 for participants with grade 1 hypertension (95% CI, 427-746) and 236 for those with grade 2 hypertension (95% CI, 154-388).
“These data suggest a low likelihood of treatment benefit, especially for those with normal and high normal BP,” Chen said in an interview. “Importantly, these findings could inform health care professionals about the effort needed to achieve a particular outcome and provide insights into the design of future clinical trials.”
For more information:
Hao Chen, MD, can be reached at chenhao@gdph.org.cn.
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