MedicalResearch: What is the background for this study? What are the main findings?
Dr. Kishi: Blood pressure (BP) at the higher end of the population distribution may represent a chronic exposure that produces chronic injury to the cardiovascular system. Cumulative BP exposure from young adulthood to middle age may adversely influence myocardial function and predispose individuals to heart failure (HF) and other cardiovascular disease (CVD) later in life. The 2005 guidelines for the diagnosis and treatment of HF from the American College of Cardiology and American Heart Association highlight the importance of early recognition of subclinical cardiac disease and the importance of non-invasive tests in the clinical evaluation of heart failure.
Our main objective was to investigate how cumulative exposure to high blood pressure from young to middle adulthood influence LV function. In the Coronary Artery Risk Development in Young Adults (CARDIA) study, multiple repeated measures of BP and other cardiovascular risk factors was recorded over a 25 year time span, starting during early adulthood (ages 18-30).
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Kishi: High cumulative exposure to blood pressure may predict clinical heart failure. Our study findings indicate that high blood pressure in early adulthood or developed during the first 25 years of early adulthood (over 25 years from age 18 to 30 years) is related to early measures of systolic and diastolic dysfunction in middle aged individuals, emphasizing the importance of prevention of high BP development early in life. These findings suggest that uncontrolled BP may increase the lifetime risk of incident heart failure in the general population.
Hypertension has been long implicated as a risk factor in a range of cardiovascular diseases. But our study suggest that pressure just below that threshold — or high normal pressure — begins to fuel heart damage in people as young as 20 and can lead to changes in myocardial function in as little as 25 years. The latest clinical guidelines issued by the JNC 8 define hypertension as blood pressure above 140/90. However, the results of the new study suggest that a single cutoff measurement does not apply to all ages and what constitutes “normal” should probably change with age.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Kishi: We relied on a subclinical end-point (LV systolic and diastolic dysfunction measured by echocardiography); our findings will need validation using clinical end-points. Further studies are needed to determine whether specific lifestyle interventions implemented to reduce blood pressure in early adulthood prevent HF from developing later in life.
Satoru Kishi, MD; Gisela Teixido-Tura, MD, PhD; Hongyan Ning, MD; Bharath Ambale Venkatesh, PhD; Colin Wu, PhD; Andre Almeida, MD; Eui-Young Choi, MD; Ola Gjesdal, MD; David R. Jacobs, Jr., PhD; Pamela J. Schreiner, PhD; Samuel S. Gidding, MD; Kiang Liu, PhD; João A.C. Lima, MD. Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study. Journal of the American College of Cardiology, June 2015
Satoru Kishi, MD Division of Cardiology, Johns Hopkins University, & Baltimore, Maryland (2015). High Blood Pressure In Young Adulthood Increases Risk Of Later Heart Failure