Author + information
- Received April 21, 2011
- Revision received June 30, 2011
- Accepted July 5, 2011
- Published online November 29, 2011.
- ↵*Reprint requests and correspondence:
Dr. Linsay Gray, MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ and London, United Kingdom
Objectives We sought to examine the association of early adulthood blood pressure with cardiovascular disease (CVD) mortality, while accounting for middle-age hypertension.
Background Elevated blood pressure in middle age is an established CVD risk factor, but evidence for association with measurements earlier in life is sparse.
Methods The HAHS (Harvard Alumni Health Study) is a cohort study of 18,881 male university students who had their blood pressure measured at university entry (1914 to 1952; mean age 18.3 years) and who responded to a questionnaire mailed in either 1962 or 1966 (mean age 45.8 years) in which physician-diagnosed hypertension status was reported. Study members were subsequently followed for mortality until the end of 1998.
Results Following adjustment for age, body mass index, smoking, and physical activity at college entry, compared with men who were normotensive according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria (&amp;amp;amp;lt;120/&amp;amp;amp;lt;80 mm Hg), there was an elevated risk of coronary heart disease (CHD) mortality (1,917 deaths) in those who were pre-hypertensive (120 to 139/80 to 89 mm Hg) (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.07 to 1.36), stage 1 (140 to 159/90 to 99 mm Hg) (HR: 1.46; 95% CI: 1.25 to 1.70), and stage 2 hypertensive (≥160/≥100 mm Hg) (HR: 1.89; 95% CI: 1.46 to 2.45), incremental across categories (ptrend &amp;amp;amp;lt; 0.001). After additionally accounting for middle-age hypertension, estimates were somewhat attenuated, but the pattern remained. Similar associations were apparent for total and CVD mortality, but not stroke mortality.
Conclusions Higher blood pressure in early adulthood was associated with elevated risk of all-cause mortality, CVD, and CHD, but not stroke, several decades later. Effects largely persisted after taking into account mediation by middle-age hypertension. Thus, the long-term benefits of blood pressure lowering in early adulthood are promising, but supporting trial data are required.
These analyses were funded by a Wellcome Trust Fellowship to Dr. Batty (grant no. WT081021), which also supports Dr. Gray, and the U.S. National Institutes of Health (grant nos. DK081141 and CA130068). The MRC/CSO Social and Public Health Sciences Unit receives funding from the MRC and the Chief Scientist Office at the Scottish Government Health Directorates (WBS U.1300.00.006.00012.01). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 21, 2011.
- Revision received June 30, 2011.
- Accepted July 5, 2011.
- American College of Cardiology Foundation