Isolated Systolic Hypertension in Young Adults Linked To Increased Risk Of Cardiovascular Death

Donald M Lloyd-Jones, MD/ScM Senior Associate Dean for Clinical and Translational Research Chair, Department of Preventive Medicine Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor Northwestern University Feinberg School of MedicineMedicalResearch.com Interview with:
Donald M Lloyd-Jones, MD/ScM
Senior Associate Dean for Clinical and Translational Research
Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS)
Eileen M. Foell Professor
Northwestern University Feinberg School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Lloyd-Jones: We undertook this study in order to understand the long-term implications of isolated systolic hypertension (that is, SBP >=140 mm Hg with DBP <90 mm Hg) in younger adults. As you may know, hypertension becomes increasingly common with age. However, it does occur in younger adults, and we are seeing early onset more often recently as a result of the obesity epidemic. In general, we know that diastolic hypertension (DBP >=90 mm Hg) is more common in younger adults, but after age 50 isolated systolic hypertension is by far the most common type of hypertension seen. Prior small studies have suggested that isolated systolic hypertension might be “benign” in younger adults, or just the result of white coat effect with no implications. However, in the current study, we observed that isolated systolic hypertension in younger adults (mean age 34 y) was in fact associated with higher risk (~25% higher risk) for cardiovascular and coronary death over 30 years’ follow up compared with “normal” levels of blood pressure. Interestingly, the relative risk was higher for young women with isolated systolic hypertension, with a doubling of coronary mortality risk. The implications of the study are that clinicians should not ignore isolated systolic hypertension in younger adults, since it clearly has implications for their future health. The USPSTF recently suggested using 24-hour ambulatory blood pressure monitoring to diagnose hypertension. Our results would support the use of this technology in younger adults suspected of having hypertension, to confirm the office-based diagnosis and define the type of hypertension to understand prognosis and inform treatment decisions.

 

Citation:

Yuichiro Yano, Jeremiah Stamler, Daniel B. Garside, Martha L. Daviglus, Stanley S. Franklin, Mercedes R. Carnethon, Kiang Liu, Philip Greenland, Donald M. Lloyd-Jones. Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality. Journal of the American College of Cardiology, 2015; 65 (4): 327 DOI: 10.1016/j.jacc.2014.10.060

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MedicalResearch.com Interview with: Donald M Lloyd-Jones, MD/ScM, Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine, & Northwestern University Feinberg School of Medicine (2015). Isolated Systolic Hypertension in Young Adults Linked To Increased Risk Of Cardiovascular Death MedicalResearch.com

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