Young adults with mild increases in blood pressure considered to be upper range of normal may develop subclinical heart damage by middle age, predisposing them to heart failure, a federally funded study conducted by Johns Hopkins University scientists has found. Findings from the study are published in the Journal of the American College of Cardiology.

Hypertension, defined as blood pressure >140/90mmHg, has been associated as a risk factor for various cardiovascular disease. This multicenter study that tracked 2,500 adults over a 25-year period suggests that blood pressure slightly below this threshold (“high normal pressure”) can start heart damage in adults as young as 20 years old and alter heart muscle function in as little as 25 years.

Cumulative blood pressure exposure over time was measured for each patient; patients were divided into groups based on how high or low the cumulative readings were. By the end of the 25-year period in 2011, patients underwent ultrasound heart imaging to assess heart function. A total of 135 of the 2,479 patients exhibited clinical heart failure on simple ultrasound. They found that those with highest diastolic pressure were 70% more likely to show abnormal relaxation vs. those with lowest diastolic pressure. Patients with persistently high systolic blood pressure were 46% more likely to have abnormal contraction.

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The cardiac abnormalities were particularly concerning because they were observed in a patient population where the majority did not have hypertension. Researchers conclude that the heart muscle may be more sensitive to subtle blood pressure elevations than previously thought.

Study findings suggest that a “normal” blood pressure should probably change with age. For example, a blood pressure of 150/90mmHg may be a realistic goal for a 60-year-old adult but may be too high for a 28-year-old. Adults with borderline pressures should receive frequent follow-ups to start treatment as soon as hypertension is diagnosed.

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