High Blood Pressure at 18 Puts You at Higher Risk for Heart Attack at Midlife

A nurse puts a blood pressure cuff on a woman.
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  • Adolescents and young adults with high blood pressure had a greater chance of having a heart attack, stroke or other cardiovascular event later in life.
  • Even those in the “elevated” blood pressure category — the first above-normal stage before high blood pressure — had an increased risk of cardiovascular events.
  • Researchers say this suggests the need for earlier measurement and management of blood pressure.

High blood pressure is a well-known risk factor for heart attack, stroke and other types of cardiovascular disease.

While this link has been well-studied in middle-aged and older people, less is known about the long-term cardiovascular risks due to high blood pressure at younger ages.

Now, a large long-term study suggests that these risks begin to accumulate even in adolescence and young adulthood.

In the study, researchers found that males with high blood pressure at age 18 were more likely to have a heart attack, stroke or other cardiovascular event over the following decades, compared to those with normal blood pressure.

This higher cardiovascular risk occurred for all blood pressure categories above normal, starting with elevated blood pressure, the first level before stage 1 high blood pressure.

The findings also showed that cardiovascular risk increased gradually across all blood pressure categories. And it applied to both elevated systolic blood pressure as well as elevated diastolic blood pressure.

Researchers estimated that 1 in 10 adolescent males with stage 2 high blood pressure would have a major cardiovascular event before retirement.

However, those with normal blood pressure at age 18 would not.

“It makes sense that blood pressure levels at relatively young ages affect our cardiovascular outcomes later in life,” said Dr. Jennifer Wong, cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. Jennifer Wong was not involved in the study.

This is similar to how “other observational trials have shown that physical activity levels in youth can affect someone’s cardiovascular outcomes later in life,” she told Healthline.

How blood pressure is measured

Blood pressure measures are given as two numbers, such as 140/90 mmHg. The first number, systolic blood pressure, measures the pressure in your arteries when the heart beats.

The second number, diastolic blood pressure, measures the pressure in your arteries when the heart is resting between beats.

Normal blood pressure is below 120/80 mmHg. Stage 1 high blood pressure is a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg.

Up to two-fold increased risk

For the observational study, published September 25 in the Annals of Internal Medicine, Swedish researchers used a national database of males enlisted in the country’s military between 1969 and 1997. 

Enlistment was mandatory for all adult male citizens during that time. Some men were excluded from the study due to illness or disability. For others, researchers did not have complete data.

Overall, they had data on around 93% of the country’s 18-year-old males during that time, including a single blood pressure measurement taken at enlistment.

Using a unique personal identification number for each Swedish citizen, researchers linked the enlistment records to hospital inpatient records and death records. They had inpatient records for over 99% of the men included in the study.

Based on the inpatient and death records, researchers identified men who had a cardiovascular event later in life, including heart attack, heart failure, stroke, bleeding in the brain, and death related to cardiovascular disease.

Researchers followed participants for an average of 36 years, and up to 50 years, after the initial blood pressure measurement.

They found that adolescent males with normal blood pressure at the time of enlistment had a 14.7% chance of having a major cardiovascular event later in life. In contrast, those with stage 2 high blood pressure had a 24.3% risk.

“Those with greater elevations of blood pressure had up to two-fold greater risks of future cardiovascular events later in life,” said Nathan D. Wong, PhD, professor and director of the Heart Disease Prevention Program at the UCI School of Medicine in Irvine, Calif. Nathan Wong was not involved in the study.

Earlier monitoring of blood pressure

The researchers point out in the paper that “clinically important differences” in cardiovascular risk appear around age 50, which they say suggests the need for close monitoring and possibly treatment at earlier ages.

Jennifer Wong agrees: “We have to pay attention to risk factors for cardiovascular disease — and elevated blood pressure is one of several risk factors that are potentially modifiable,” she said. “So it’s extremely important that we look at these early on in life.”

Other cardiovascular risk factors that can be modified include cholesterol levels, dietary habits and whether someone is overweight or has obesity, she said.

Although the study included a large number of adolescents and followed them for several decades, there are several limitations to the research.

For example, because the study included only men, the risks due to high blood pressure in adolescence may be different for women. Nathan Wong pointed out, though, that other research suggests that the findings will be similar for women.

However, because the study was carried out in Sweden with little diversity in the population, the study results may not be the same for other countries or for other ethnic and racial groups, the researchers said.

In addition, the study is observational, so researchers could not account for other factors that can increase the risk of cardiovascular events, such as smoking, alcohol consumption and blood cholesterol. 

Lifestyle changes for healthy blood pressure

Jennifer Wong said blood pressure measurement should be a routine part of every checkup at a doctor’s office, including for children.

Beyond that, Nathan Wong encourages young adults to “know their blood pressure numbers” and take action to reduce their risk of future cardiovascular events.

“Prior studies show that even those with mild elevations in blood pressure often progress to developing [diagnosed] hypertension within a few years, hence the importance of addressing this earlier rather than later,” he told Healthline.

“Furthermore, elevations in blood pressure are associated with other problems such as kidney disease and diabetes,” he added.

Dr. Christopher Tanayan, cardiologist at Northwell Health’s Lenox Hill Hospital in Manhattan, agrees that earlier blood pressure measurement and management is a good idea. 

“Prevention is better than cure,” he told Healthline, especially since “damage from high blood pressure typically happens slowly, over many years.”

He recommends that even older adolescents aim for blood pressure levels below 120/80 mmHg. As the study shows, “the higher the blood pressure, the higher the incidence of bad events [later in life], starting with just ‘elevated’ blood pressure,” he said.

Nathan Wong said most young adults with blood pressure below 140/90 mmHg can control their blood pressure through lifestyle management, including weight control, physical activity and sodium restriction. 

Those with more severe high blood pressure may need medications, on top of lifestyle changes, to help control their blood pressure, he said.

While middle-aged and older adults are often prescribed medications to help lower their blood pressure, Tanayan cautioned that more research is needed to know if the benefits of these drugs in younger adults outweigh the risk of side effects, particularly for those in the “elevated” blood pressure category.

So “a study on the potential cons of aggressive treatment with medications on a young population must be done,” he said.

Takeaway

A large long-term study found that 18-year-old males with elevated or high blood pressure had a higher risk later in life of cardiovascular events such as heart attack and stroke, compared to those with normal blood pressure.

Those in the most severe category — stage 2 high blood pressure — had around a two-fold increased risk of cardiovascular events.

Researchers say this suggests the need for earlier measurement and management of blood pressure. For some, blood pressure control can be accomplished with lifestyle changes such as maintaining a healthy weight, limiting sodium intake and exercising regularly.

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