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Studies raise key questions on hypertension in adults under 40.

THESE TWO STUDIES suggest that a higher blood pressure level in young adulthood is associated with a greater hazard of premature cardiovascular disease, according to Ramachandran S. Vasan, MD.

However, observing an elevated risk of premature cardiovascular disease does not necessarily prove causality, or establish that intervening to lower blood pressure in this age group would lessen that risk, he said in an editorial.

The studies are notable for showing that half to nearly 60% of younger adults had levels of blood pressure considered not normal, he added in the editorial, which appears in JAMA.

It is not clear why so many young adults would manifest higher blood pressure levels in these studies, he said, noting that the umbrella of young adults with hypertension likely includes patients with a variety of subtypes. Those include white-coat hypertension, peripheral amplification with normal central blood pressure, hyperadrenergic state, isolated systolic hypertension, and a smaller subset with secondary hypertension.

These distinct pathophenotypes may have varying natural histories and their management approaches may be distinctive, suggesting the importance and potential role of subphenotyping of elevated blood pressure in young adults to facilitate treatment decisions," he wrote in his editorial.

The two studies raise key questions, such as whether there are modifiable social, behavioral, or cultural factors that could prevent elevated blood pressure in younger people, he said.

To date, a substantial body of evidence does suggest that blood pressure levels evolve over the course of life, driven by environmental factors superimposed on genetic risks, and modified by sex and race.

"Overall, these data emphasize that primary prevention of higher blood pressure levels must begin in childhood," he said.

Dr. Ramachandran S. Vasan is with the section of preventive medicine and epidemiology at Boston University. He reported no conflict of interest disclosures related to his editorial, which was supported by the National Heart, Lung, and Blood Institute's Framingham Heart Study and a grant from the National Institutes of Health (JAMA. 2018;320[17]:1760-3. doi:10.1001/jama.2018.16068).

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Title Annotation:VIEW ON THE NEWS
Author:S., Ramachandran
Publication:Internal Medicine News
Date:Jan 1, 2019
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