Study: BP increase at middle age may indicate lifetime risk of cardiovascular disease

Individuals who are able to maintain or decrease their blood pressure (BP) to normal levels during middle age have the lowest lifetime risk for cardiovascular disease (CVD). In contrast, individuals who experience an increase in BP have higher lifetime risks (LTRs), according to a study published in Circulation.

“Avoiding hypertension before middle age and delaying the onset of the development of hypertension both appear to have a significant impact on an individual’s remaining lifetime risk for CVD,” wrote Norrina Allen, PhD, of the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, and colleagues.

The researchers examined the impact of blood-pressure changes over time during middle age on lifetime risk for cardiovascular disease by using data from the Cardiovascular Lifetime Risk Pooling Project. They followed 61,585 white and black men and women from an index age of 55 for 695,394 person-years. The participants were followed until the occurrence of a first CVD event, death, or until they reached age 95 years.

The data demonstrated that the remaining lifetime risk for CVD, starting at age 55 years, was 52.5% (95% CI, 51.3–53.7) for men and 39.9% (38.7–41.0) for women. For coronary heart disease (CHD), lifetime risk was 30.9% (95% Cl, 29.8–31.9%) for men and 17.5% (16.6–18.3%) for women. And, for stroke, remaining lifetime risk was 11.2% (95% Cl, 10.3–12.1%) for men and 14.7% (13.6–15.8%) for women. Black participants reached a higher LTR at a younger age than white participants at almost all blood-pressure levels, the investigators noted.

The authors noted that women who developed hypertension by age 41 years had a higher lifetime risk for CVD and CHD compared to those who had developed hypertension late by age 55 years. A similar pattern was seen among men when examining the remaining lifetime risk of stroke, suggesting there may be a dose-response effect for length of time at higher blood pressures.

“Taking blood pressure changes into account can provide more accurate estimates for lifetime risk for cardiovascular disease and represent a step forward in developing individualized risk prediction strategies,” the authors wrote.