High-Normal Blood Pressure in Young Adults as a Risk for Atherosclerosis Later in Life

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The summary below is from the full report titled "Prehypertension during Young Adulthood and Coronary Calcium Later in Life." It is in the 15 July 2008 issue of Annals of Internal Medicine (volume 149, pages 91-99). The authors are M.J. Pletcher, K. Bibbins-Domingo, C.E. Lewis, G.S. Wei, S. Sidney, J.J. Carr, E. Vittinghoff, C.E. McCulloch, and S.B. Hulley.

What is the problem and what is known about it so far?

Hypertension is high blood pressure. It is important because it makes a person more likely to develop atherosclerosis, a thickening of blood vessel walls that can lead to heart attacks and strokes. People with atherosclerosis sometimes accumulate calcium in their blood vessel walls. A special form of computed tomography (CT scan) can detect calcium in the blood vessels of the heart (coronary arteries). People with lots of calcium in their coronary arteries are more likely to have heart attacks and strokes. Recently, researchers have recognized that blood pressure levels lower than those usually considered abnormal might still be harmful (prehypertension). The effect of prehypertension on risk for heart attacks and strokes is not entirely clear. Showing that prehypertension contributes to coronary artery calcium would suggest that it is harmful. It would also suggest that the line doctors draw to distinguish harmful from safe blood pressure levels might be lowered.

Why did the researchers do this particular study?

To see whether young adults with prehypertension are more likely to have calcium buildup in coronary arteries later in life.

Who was studied?

3560 young adults participating in a long-term study of heart health.

How was the study done?

The researchers measured participants' blood pressure over 15 to 20 years. At the end of that period, they obtained a CT scan to measure coronary artery calcium. They then compared the probability of having coronary artery calcium in participants with and without prehypertension.

What did the researchers find?

Participants with prehypertension were more likely to have calcium in their coronary arteries. The probability of having coronary artery calcium was greater in people with higher levels of prehypertension and in those who had it for a longer time.

What were the limitations of the study?

Not everyone with coronary artery calcium develops heart attacks and other diseases. The findings therefore are suggestive but not definitive. Also, the findings could be caused by factors other than those that the researchers measured.

What are the implications of the study?

Prehypertension in young adulthood makes a person more likely to have coronary artery calcium and atherosclerosis later in life. The findings suggest that people between 20 and 35 years of age should pay attention to blood pressures between 120/80 and 139/89 mm Hg.