“Alarming” Findings – High blood pressure can cause heart damage in adolescents

Man heart attack chest pain illustration

High blood pressure, also known as hypertension, is a common yet silent health problem that affects millions of people worldwide. Often without noticeable symptoms, this condition increases the force of blood against the walls of your arteries, potentially leading to serious health complications over time, such as heart disease, stroke, and kidney failure.

A recent study published in the Journal of Pediatrics highlights the adverse effects of elevated blood pressure and hypertension during adolescence, leading to early heart damage that is exacerbated by young adulthood. This joint research effort between the University of Bristol (UK) and the University of Eastern Finland highlights the importance of addressing blood pressure problems early in life to prevent potential long-term health complications.

Elevated blood pressure and hypertension, often referred to as “silent killer diseases” in adults, are notorious for causing damage to the kidneys, heart, blood vessels and brain, ultimately resulting in death. The global cost of treating hypertension is billions of dollars a year and is associated with an increasing number of health emergencies, including heart attacks and strokes.

The European Society of Cardiology/European Society of Hypertension classifies a blood pressure of 130/85 mmHg as high normal and 140/90 mmHg as hypertension. While the American College of Cardiology/American Heart Association classifies a blood pressure of 130/80 mmHg as hypertension.

Elevated blood pressure and hypertension can cause premature heart damage in young people

Elevated blood pressure and hypertension can cause premature heart damage in childhood. Blood pressure screening and prevention are urgently needed in the young population. Credit: Andrew Agbaje

In 2020, the United States Preventive Services Task Force concluded, “that the evidence supporting high blood pressure screening in children and adolescents is insufficient and the balance of benefits and harms cannot be determined.”

However, last year (2022) it was reported that elevated systolic blood pressure during childhood was associated with the risk of premature death in the mid-40s. Nevertheless, the earliest time to reveal potential high blood pressure-related heart damage in a general population of children and adolescents remains unknown.

In addition, it is unclear whether hypertension greater than 130/85 mmHg plays a causative role in early cardiac injury in the young population due to the lack of repeated echocardiographic measurements.

The current study was conducted in 1,856 adolescents, of whom 1,011 were female. The adolescents were 17 years old at baseline and were followed for 7 years until young adulthood at age 24. Elevated blood pressure and hypertension, and evidence of cardiac damage were assessed at baseline and follow-up.

Signs of damage to heart structure are left ventricular hypertrophy and high relative wall thickness, while signs of damage to heart function are left ventricular diastolic dysfunction and increased left ventricular filling pressure.

During the 7-year follow-up period, the prevalence of elevated blood pressure and hypertension and heart damage doubled in adolescents. With comprehensive monitoring of fat mass, muscle mass, glucose, lipids, smoking status, sedentary time, physical activity and family history of cardiovascular disease, and the use of adult crosscuts for diagnosing heart damage, high blood pressure and hypertension were observed to cause premature heart damage in both men and women.

Importantly, specific features of elevated blood pressure and hypertension-related heart damage were observed in each sex. For example, in men, high systolic blood pressure and hypertension were associated with an approximately 10-30% increased risk of damage to heart function, but there was no risk of damage to heart structure.

However, in women, high systolic blood pressure and hypertension were associated with approximately a 60-217% increased risk of damage to heart structure and a 35-65% increased risk of damage to heart function.

“This new evidence on the detrimental effect of high blood pressure and primary hypertension on the heart of the young population is alarming. Delay in starting blood pressure screening in adolescence is unjustifiable given the amount of heart damage and possible premature death that could be prevented. Therefore, public health experts, health policy makers, health journalists and bloggers, pediatricians and healthcare providers are encouraged to significantly raise awareness of the critical danger high blood pressure and hypertension pose to young people. Legislative changes enforcing blood pressure screening in adolescents should be pushed for, as it can significantly reduce hypertension-related emergencies in adulthood,” said Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.

Reference: “Elevated Blood Pressure and Aggravation of Heart Damage in Adolescence” By Andrew O. Agbaje MD, MPH, March 3, 2023, The Journal of Pediatrics.
DOI: 10.1016/j.jpeds.2023.02.018

The research group of Dr. Agbaje (urFIT child) is supported by research grants from the Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation sr, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, de Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, and the Foundation for Pediatric Research.

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