Abstract
Importance: Little is known regarding the association between level of blood pressure (BP) in young adulthood and cardiovascular disease (CVD) events by middle age. Objective: To assess whether young adults who developed hypertension, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, before age 40 years have higher risk for CVD events compared with those who maintained normal BP. Design, Setting, and Participants: Analyses were conducted in the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, started in March 1985. CARDIA enrolled 5115 African American and white participants aged 18 to 30 years from 4 US field centers (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California). Outcomes were available through August 2015. Exposures: Using the highest BP measured from the first examination to the examination closest to, but not after, age 40 years, each participant was categorized as having normal BP (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n = 2574); elevated BP (untreated SBP 120-129 mm Hg and DBP <80 mm Hg; n = 445); stage 1 hypertension (untreated SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1194); or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking antihypertensive medication; n = 638). Main Outcomes and Measures: CVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD). Results: The final cohort included 4851 adults (mean age when follow-up for outcomes began, 35.7 years [SD, 3.6]; 2657 women [55%]; 2441 African American [50%]; 206 taking antihypertensive medication [4%]). Over a median follow-up of 18.8 years, 228 incident CVD events occurred (CHD, 109; stroke, 63; heart failure, 48; PAD, 8). CVD incidence rates for normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.37 (95% CI, 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1000 person-years, respectively. After multivariable adjustment, hazard ratios for CVD events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.67 (95% CI, 1.01-2.77), 1.75 (95% CI, 1.22-2.53), and 3.49 (95% CI, 2.42-5.05), respectively. Conclusions and Relevance: Among young adults, those with elevated blood pressure, stage 1 hypertension, and stage 2 hypertension before age 40 years, as defined by the blood pressure classification in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, had significantly higher risk for subsequent cardiovascular disease events compared with those with normal blood pressure before age 40 years. The ACC/AHA blood pressure classification system may help identify young adults at higher risk for cardiovascular disease events.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1774-1782 |
| Number of pages | 9 |
| Journal | JAMA - Journal of the American Medical Association |
| Volume | 320 |
| Issue number | 17 |
| DOIs | |
| State | Published - Nov 6 2018 |
Funding
Development in Young Adults Study (CARDIA) was conducted and supported by grants HHSN268201300025C and HHSN268201300026C from NHLBI in collaboration with the University of Alabama at Birmingham, HHSN268201300027C from Northwestern University, HHSN268201300028C from the University of Minnesota, HHSN268201300029C from the Kaiser Foundation Research Institute, HHSN268200900041C from Johns Hopkins University School of Medicine, P20GM104357 from the National Institute of General Medical Sciences of the NIH (Dr Yano), 15SFRN2390002 from the American Heart Association (Dr Muntner), K24-HL125704 from NHLBI (Dr Shimbo), and by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Colangelo reported Northwestern University receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Dr Gidding reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Bress reported receiving grants from Novartis and Amarain outside the submitted work. Dr Greenland reported receiving grants from NIH during the conduct of the study. Dr Muntner reported receiving grants from Amgen Inc outside the submitted work. No other disclosures were reported.
ASJC Scopus subject areas
- General Medicine
