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NO patient should reach the age of 18 years without their GP knowing their blood pressure according to experts, after new research highlighted the long-term cardiac effects of cumulative exposure to higher blood pressure that starts in young adulthood.
Professor Stephen Harrap, head of the department of physiology at the University of Melbourne and specialist physician at the Royal Melbourne Hospital, told MJA InSight that the effect of high blood pressure (BP) on cardiac function was often overlooked, with a bigger focus placed on the risk of stroke and renal failure.
“But the truth is, blood pressure is a cause of heart failure and this process can begin early on in life.”
Professor Harrap was commenting on a study published last week in the Journal of the American College of Cardiology, which found that higher cumulative exposure to BP in the 25 years from young adulthood to middle age was associated with cardiac dysfunction. (1)
The authors followed 2479 healthy young men and women aged 18‒30 years at baseline, who were prospectively monitored in seven subsequent examinations.
At the year 25 examination, left ventricular (LV) function was measured by two-dimensional echocardiography (ECG), and cardiac deformation was assessed in detail by speckle-tracking ECG.
The researchers found that cumulative exposure to BP over 25 years from young adulthood to middle age was associated with incipient LV systolic and diastolic dysfunction in middle age. The authors said that in early adulthood, diastolic BP control could be of particular importance to prevent LV dysfunction and heart failure.
An accompanying editorial said the study raised critical questions about the significance of BP early in life, and highlighted “the need for longitudinal studies commencing in childhood”. (2)
Professor Jaye Chin-Dusting, president of the High Blood Pressure Research Council of Australia and head of vascular disease research at Baker IDI Heart and Diabetes Institute, welcomed the study, saying it underscored the serious impact of the link between hypertension and heart failure.
“The take home message here is that it is never too early to know your blood pressure, because high blood pressure can be controlled with lifestyle changes and, where required, very effective medication”, she said.
Professor Chin-Dusting said that aside from heart failure, high BP was a contributing factor to the development of stroke, chronic kidney disease and poor vessel function in the form of atherosclerosis, which could potentially lead to heart attacks.
Professor Harrap agreed, saying the increased chance of a hypertensive patient developing atrial fibrillation was another commonly under-recognised risk factor.
“What happens is the high blood pressure can cause a dilation of the left atrium, which can then create instability in the heart.”
Professor Harrap said that even slight elevations from normal BP levels among young people “could result in cardiac function towards the lower end of the scale when they are older”.
He said that with the increasing prevalence of childhood obesity, Australia could begin to see even more young adults diagnosed with hypertension, because “blood pressure and body weight are closely tied together”.
Professor Chin-Dusting said the medical community could be proactive in easing any future burden of hypertension.
In younger patients, GPs could look out for similar BP risk factors that they use to assess older patients
“These include inherited propensity, lifestyle choices such as a sedentary lifestyle, smoking, poor nutrition leading to obesity, and of course chronic high stress levels are a big player.”
As long as high BP was picked up early, “addressing this condition is very achievable and can make a huge difference to a person’s health and wellbeing in later life”, Professor Chin-Dusting said.
(Photo: creo77 / shutterstock)
Following on from Dr Vincent Felliti’s ACE study, “Adverse Childhood Experiences” and their impact on the Fight, Flight, Freeze response of the Autonomic Nervous System and subsequent chronic changes to the Hypothalamic- Pituatary Adrenal axis, when reviewing children and young adults with hypertension, we need to look at something more than numbers. Only now, as a society, are we beginning to accept that many people have been subjected to dreadful physical, sexual and emotional abuse as children. Taking BPs and prescribing medication or even lifestyle change is far from the full answer to this problem. This is as much a problem of Sociology, Psychology and trauma as a problem with physiology. This lies literally at the heart of the mind/body split in Western Medicine with which we have been afflicted since the time of Descartes. What becomes of the brokenhearted? As doctors, we need to fix a lot more than numbers signifying systolic and diastolic BP. High blood pressure is just a silent marker of a whole organism in distress.