- Researchers say inconsistent blood pressure readings in adults in their 20s and 30s may indicate a higher risk for heart disease later in life.
- They say the study indicates the need for younger adults to have blood pressure measured at least once a year.
- They say younger adults with variable blood pressure readings should adopt lifestyle changes that lower their risk of cardiovascular disease.
Inconsistent blood pressure readings in young adulthood may be an indicator of cardiovascular disease later in life.
“Current guidelines defining hypertension and assessing the need for antihypertensive therapies ignore variability in blood pressure readings,” said Dr. Yuichiro Yano, a lead investigator in the study and an assistant professor in the department of family medicine and community health at Duke University in North Carolina.
“I think there has been a belief that variability is a chance phenomenon, but this research indicates maybe not. Variability matters,” Yano said in a statement.
What the long-term data shows
The research involved 3,394 participants.
Blood pressure was measured three times in 1-minute intervals at an initial exam and then 2, 5, 7, and 10 years later.
Ten years into the study, the average age of participants was 35. Three percent were taking antihypertensive medication.
They also had follow-up exams at 15, 20, 25, and 30 years.
The researchers found that greater variability from visit to visit before age 40 was associated with a higher risk for cardiovascular disease and all-cause mortality in later decades.
In the follow-up period, there were 162 cardiovascular disease events. These included:
- stent procedures for peripheral artery disease
- transient ischemic attack
- heart disease
- heart failure
There were 181 deaths.
Analysis found that a 3.6-mm spike in blood pressure during young adulthood was associated with a 15 percent higher risk of cardiovascular disease events in later years.
The researchers suggest that assessing visit-to-visit systolic blood pressure variability could help identify at-risk young adults.
Systolic blood pressure is the top number. It represents the amount of pressure in your arteries while your heart muscle is contracting.
The bottom number is diastolic blood pressure, which measures pressure between heartbeats.
Of the study participants, 54 percent were white and 46 percent were African American. Slightly more than half were women.
Study authors acknowledge that these results may not be pertinent to other racial or ethnic groups.
Experts weigh in
Dr. Jim Liu is a cardiologist at The Ohio State University Wexner Medical Center.
Liu told Healthline that this research shows that blood pressure variability could potentially identify younger adults who are at higher risk for cardiovascular disease and cardiovascular mortality independent of their mean blood pressure readings.
It’s something for healthcare providers to think about, said Liu.
He also stressed the need for more research before changing habits or guidelines.
Dr. Brian Kolski is director of the structural heart disease program at St. Joseph Hospital in Orange County, California.
“It is unclear why systolic blood pressure variability may lead to an increased risk of heart disease,” Kolski told Healthline.
“This study is thought-provoking because blood pressures were measured more frequently than is typically seen in a healthy population,” he added.
Averaging blood pressure
Currently, doctors average blood pressure readings.
Liu explained that a variety of factors cause fluctuations in blood pressure. That’s why it’s important not to use a single measurement as a guide to management.
“Based on the most recent ACC/AHA guidelines, hypertension is defined as a systolic blood pressure over 130 mm Hg or a diastolic blood pressure of over 80 mm Hg. This should be based on an average of more than two readings obtained on more than two separate occasions,” said Liu.
“In young otherwise healthy adults without hypertension, blood pressure should be checked at least once a year. In someone with hypertension, blood pressure should be checked more frequently,” he continued.
Liu cautioned that blood pressure cuffs shouldn’t be placed over sleeves.
“There are very specific, standardized instructions for how to take a blood pressure measurement properly. This includes things like resting and sitting in a chair with back supported and feet on the ground for at least 5 minutes before measuring blood pressure, emptying the bladder before measurement, no talking while measurement is taking place, and making sure the cuff size is correct and properly located on the arm,” he advised.
As long as blood pressure monitors have been validated, it’s acceptable to use blood pressure machines you see in pharmacies or those intended for home use, said Liu.
“In general, arm cuffs are recommended instead of wrist cuffs. Wrist cuffs can be inaccurate if not used correctly. The other thing is to make sure that the arm cuff size is correct. Having a cuff that is too big or too small may also give inaccurate readings,” he added.
The silent killer
Liu said that hypertension is called the “silent killer” for a reason.
Although some people may develop a headache, shortness of breath, or chest pain, most people with high blood pressure have no symptoms.
“If these symptoms are present, you should see a healthcare provider to see if high blood pressure could be the cause,” said Liu.
Kolski noted that this may prompt your doctor to look into secondary causes of hypertension, such as kidney disease or thyroid disease.
For young adults whose blood pressure isn’t within the normal range, Kolski said doctors will likely recommend lifestyle and diet modification first.
Medication can be added if it’s still uncontrolled.
“This may be the only takeaway from the study — that normal young adults should probably have their blood pressure checked at least yearly,” said Kolski.
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