Blood pressure targets and the young adult: Are we being too stringent? – The BMJ

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Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

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Blood pressure targets and the young adult: Are we being too stringent?

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

Dear Editor,

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

Hypertension is a harbinger of tremendous burden of cardiovascular disease globally, including low- and middle-income countries (LMIC), with an estimate one in three adults suffering from hypertension in LMICs. These figures hail from when hypertension was erstwhile defined as blood pressure ≥140/90 mm Hg (Ref1). Hence, the burden is likely to be greater given the current definition of hypertension as blood pressure ≥ 130/80 mm Hg (Ref 2).
In the article ‘Association between high blood pressure and long-term cardiovascular events: systematic review and meta-analysis,’ Luo et al. have pooled data from 17 observational studies of above 4.5 million young adults in the age group of 18 to 45 years, with an average follow-up of 14.7 years (Ref 3).The authors report a graded increase in adverse cardiovascular outcomes with progressively increasing grades of blood pressure (BP) severity. This is an extremely important study for the reason that studies of cardiovascular outcomes in hypertensive adults, by and large, focus on middle-aged and older adults. The prevalence of hypertension in younger adults is steadily increasing but robust data on long-term cardiovascular effects of hypertension in this specific population is lacking as of now (Ref 4,5).
An interesting observation in this meta-analysis was the progressive increase in risk of stroke with increase in BP compared to optimal BP (defined as BP The authors also note the graded influence of isolated systolic and diastolic BP on cardiovascular outcomes. In a recently published cohort of above 6 million young adults with a mean age of 30 years and follow-up of 13.2 years, adjusted hazard ratios for new cardiovascular events were 1.32 (95% CI 1.28-1.36) for stage 1 isolated diastolic hypertension (defined as diastolic BP 80-89 with systolic BP

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

References:
1. Sarki AM, Nduka CU, Stranges S, Kandala N-B, Uthman OA. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2015;94(50):e1959. doi:10.1097/MD.0000000000001959
2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens Dallas Tex 1979. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066
3. Luo D, Cheng Y, Zhang H, et al. Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ. 2020;370. doi:10.1136/bmj.m3222
4. Go Alan S., Mozaffarian Dariush, Roger Véronique L., et al. Heart Disease and Stroke Statistics—2014 Update. Circulation. 2014;129(3):e28-e292. doi:10.1161/01.cir.0000441139.02102.80
5. De Venecia T, Lu M, Figueredo VM. Hypertension in young adults. Postgrad Med. 2016;128(2):201-207. doi:10.1080/00325481.2016.1147927
6. Lee H, Yano Y, Cho SMJ, et al. Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults. Circulation. 2020;141(22):1778-1786. doi:10.1161/CIRCULATIONAHA.119.044838

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

Competing interests: No competing interests

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ

12 September 2020 Divyani Garg Assistant Professor, Neurology Ayush Agarwal Lady Hardinge Medical College Department of Neurology, Lady Hardinge Medical College, New Delhi @Divyani_Garg

Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ
Blood Pressure Targets And The Young Adult: Are We Being Too Stringent? - The BMJ