Benefits of Managing Mild Hypertension in Younger Patients

​ Interview with:
Eleni Rapsomaniki, PhD
The Farr Institute of Health Informatics Research
Department of Epidemiology & Public Health
University College London London

MedicalResearch: What are the main findings of the study?

Dr. Rapsomaniki: Our data shows that hypertension is associated with considerable reduction in CVD-free life expectancy. Based on our estimates a 30-year old with hypertension suffered from CVD 5 years earlier compared to a similarly aged individual with normal blood pressure.

We noted substantial heterogeneity in the associations of blood pressure with specific cardiovascular outcomes. For example a 20 mmHg increase in systolic blood pressure was associated with ~40% higher risk of stable angina, and intracerebral or subarachnoid haemorrhage but less than 10% increase in risk of abdominal aortic aneurysm.

In all age groups from 30 to over 80 people with a systolic blood pressure 90–114 mm Hg and a diastolic blood pressure of 60–74 mm Hg had the lowest risk of all cardiovascular diseases, and we found no J-shape associations.

MedicalResearch: Were any of the findings unexpected?

Dr. Rapsomaniki: A widely held assumption was that systolic and diastolic blood pressures have similar associations with different outcomes, as they are strongly correlated. However, we found discordance in the associations of systolic and diastolic blood pressures with abdominal aortic aneurysm (strongly associated with DBP and weakly with SBP) and peripheral arterial disease (strongly associated with SBP and weakly with DBP). Prior literature on these associations has been sparse and our study may contribute to a further understanding of the biological mechanisms underlying these different associations.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Rapsomaniki: The lifetime burden associated with hypertension is substantial and not confined to the elderly. Lifestyle changes to control hypertension and other cardiovascular risk factors are likely to have benefits that are evident from a young age, e.g. by reducing the incidence of stable and unstable angina which accounted for half of the life years lost in patients who were hypertensive at age 30.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Rapsomaniki: Our data provides circumstantial evidence for managing mild hypertension in younger people. Based on our findings future trials examining the benefits of blood pressure treatments in younger populations could focus on coronary artery disease endpoints (including stable angina) as these are more likely to be observed in young populations during the relatively short trial periods. We also need more trials that focus on reducing risk of cardiovascular diseases beyond heart attack and stroke. For example, heart failure was among the most common initial presentations of CVD in our elderly hypertensive population but trials for antihypertensive agents to prevent heart failure are lacking.

Crucially, the linkage of electronic health records has provided us with a unique opportunity to study the patient pathway from health, to milder forms of cardiovascular disease, to acute events and death. The value of this data for research into how to optimize the allocation of preventive interventions cannot be stressed enough.


Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people
Dr Eleni Rapsomaniki PhD,Prof Adam Timmis FRCP,Julie George PhD,Mar Pujades-Rodriguez PhD,Anoop D Shah MRCP,Spiros Denaxas PhD,Ian R White PhD,Prof Mark J Caulfield MD,Prof John E Deanfield FRCP,Prof Liam Smeeth FRCGP,Prof Bryan Williams FRCP,Prof Aroon Hingorani FRCP,Prof Harry Hemingway FRCP
The Lancet – 31 May 2014 ( Vol. 383, Issue 9932, Pages 1899-1911 )
DOI: 10.1016/S0140-6736(14)60685-1