Association of blood pressure classification in young adults using the 2017 American College of Cardiology/American Heart Association blood pressure guideline with cardiovascular events later in life

JAMA Nov 09, 2018

Yano Y, et al. - Researchers investigated if a higher risk for cardiovascular disease events is seen among adults who develop hypertension (defined using the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) blood pressure guideline) before age 40 years vs those who maintain normal blood pressure. According to findings, a significantly higher risk for subsequent cardiovascular disease events was observed among young adults with elevated blood pressure, stage 1 hypertension, and stage 2 hypertension before age 40 years, as defined by the blood pressure classification in the 2017 ACC/AHA guidelines vs those with normal blood pressure before age 40 years. Young adults at higher risk for cardiovascular disease events may be detected with the help of ACC/AHA blood pressure classification system.


  • In the prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) study, a total of 5,115 African American and white participants aged 18 to 30 years from 4 US field centers (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California) were enrolled.
  • Researchers conducted analyses in the prospective cohort CARDIA study, started in March 1985; through August 2015, outcomes were available.
  • Each participant, on the basis of the highest BP measured from the first examination to the examination closest to, but not after, age 40 years, was categorized as having normal BP (untreated systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n = 2574); elevated BP (untreated SBP 120-129 mm Hg and DBP <80 mm Hg; n = 445); stage 1 hypertension (untreated SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1194); or stage 2 hypertension (SBP ≥140 mm Hg, DBP ≥90 mm Hg, or taking antihypertensive medication; n = 638).
  • Main outcomes and measures included CVD events: fatal and nonfatal coronary heart disease (CHD), heart failure, stroke, transient ischemic attack, or intervention for peripheral artery disease (PAD).


  • A total of 4,851 adults comprised the final cohort (mean age when follow-up for outcomes began, 35.7 years [SD, 3.6]; 2,657 women [55%]; 2,441 African American [50%]; 206 taking antihypertensive medication [4%]).
  • There were 228 incident CVD events documented over a median follow-up of 18.8 years (CHD, 109; stroke, 63; heart failure, 48; PAD, 8).
  • For normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension, the observed CVD incidence rates were 1.37 (95% CI, 1.07-1.75), 2.74 (95% CI, 1.78-4.20), 3.15 (95% CI, 2.47-4.02), and 8.04 (95% CI, 6.45-10.03) per 1,000 person-years, respectively.
  • For elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP, the hazard ratios for CVD events were 1.67 (95% CI, 1.01-2.77), 1.75 (95% CI, 1.22-2.53), and 3.49 (95% CI, 2.42-5.05), respectively, after multivariable adjustment.
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