High normal blood pressure and left ventricular structural and functional disorders in young adults

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.

Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.

Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.

Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

1. Luo D, Cheng Y, Zhang H, et al. Association between high blood pressure and long-term cardiovascular events in young adults: systematic review and meta-analysis. BMJ. 2020;370(10):410-14. doi:10.1136/bmj.m3222.

2. Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. doi:10.1093/eurheartj/ehy339.

3. Kobalava ZD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.) doi:10.15829/1560-4071-2020-3-3786.

4. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/ PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Whelton PK, Carey RM, Aronow WS, et al. Hypertension. 2018;71:e13-115. doi:10.1161/HYP.0000000000000065.

5. Jackson T, Wright Jr, Jeff D, et al. A randomized trial of intensive versus standard blood-pressure control. NEJM. 2015;373(22):2103-16. doi:10.1056/NEJMoa1511939.

6. Fisher NDL, Curfman G. Hypertension — a public health challenge of global proportions. JAMA. 2018;320(17):1757-9. doi:10.1001/jama.2018.16760.

7. Boytsov SA, Balanova YuA, Shalnova SA, et al. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4-14. (In Russ) doi:10.15829/1728-88002014-4-4-14.

8. Miura K, Daviglus ML, Dyer AR, et al. Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Int Medicine. 2001;161(12):1501-8. doi:10.1001/archinte.161.12.1501.

9. Vasan RS. High Blood Pressure in Young Adulthood and Risk of Premature Cardiovascular Disease: Calibrating Treatment Benefits to Potential Harm. JAMA. 2018;320(17):1760-3. doi:10.1001/jama.2018.16068.

10. Bundy JD, Jaeger BC, Huffman MD, et al. Twenty-Five-Year Changes in Office and Ambulatory Blood Pressure: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hyper. 2020;20:316-20. doi:10.1093/ajh/hpaa189.

11. Shavarova EK, Kobalava ZD, Ezhova NE, et al. Early structural and functional left ventricular disorders in young patients with hypertension: a role of insulin resistance. Russian Journal of Cardiology. 2020;25(3):3774. (In Russ.) doi:10.15829/1560-4071-2020-3-3774.

12. Cuspidi C, Facchetti R, Bombelli M, et al. High normal blood pressure and left ventricular hypertrophy echocardiographic findings from the PAMELA population. Hypertension. 2019;73:612-9. doi:10.1161/HYPERTENSIONAHA.118.12114.

13. Ishikawa Y, Ishikawa J, Ishikawa S, et al. Jichi Medical School Cohort Investigators Group. Progression from prehypertension to hypertension and risk of cardiovascular disease. J Epidemiol. 2017;27:8-13. doi:10.1016/j.je.2016.08.001.

14. De Marco M, de Simone G, Roman MJ, et al. Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: the Strong Heart Study. Hypertension. 2009;54:974-80. doi:10.1161/HYPERTENSIONAHA.109.129031.

15. Nadruz W. Myocardial remodeling in hypertension. J Hum Hyper. 2015;29(1):1-6. doi:10.1038/jhh.2014.36.

16. Khadzegova AB, Sinitcina IA, Borschevskaya MV. Influence of left ventricular remodeling on indicators of functional state in patients with arterial hypertension. Therapy. 2019;5(4):28-34. (In Russ.) doi:10.18565/therapy.2019.4.28-34.

17. Ladeiras-Lopes R, Fontes-Carvalho R, Vilela EM, et al. Diastolic function is impaired in patients with prehypertension: data from the EPIPorto study. Revista Espanola de Cardiologia (English Edition). 2018;71(11):926-34. doi:10.1016/j.rec.2017.11.015.

18. Materson BJ, Garcia-Estrada M, Degraff SB, et al. Prehypertension is real and can be associated with target organ damage. J Am Soc Hypert. 2017;11(11):704-8. doi:10.1016/j.jash.2017.09.005.