New study suggests benefit of earlier-life blood pressure checks and management

The risks associated with high blood pressure are seen from as young as 36 years, say UK researchers who highlight the need for regular checks before middle age.

Rather than intervening once someone has hypertension, doctors should track people’s long-term patterns and watch out for people who have ‘normal’ blood pressure which is rising steeply, the team from University College London said.

It comes after a study in 500 patients who had taken part in a large national longitudinal study that took blood pressure readings at the ages of 36, 43, 53, 62, 69 and 77 years.

Detailed heart scans showed that having higher blood pressure at all of these ages was linked to poorer blood flow to the heart muscle in later life.

Reporting the findings in the journal Circulation: Cardiovascular Imaging, they said that every 10-point increase in systolic blood pressure – for example, from 120 to 130mmHg – between the ages of 36 and 69 was linked to up to a 6% reduction in myocardial perfusion at age 77.

The largest impact was seen between ages of 43 and 63, when average systolic blood pressure rose from 120 to 140mmHg.

Every 10-point rise in blood pressure was linked to a 9- 12% reduction in blood flow to the heart at the age of 77.

The more years people spent with higher blood pressure, and the more sharply it rose, the larger the reduction in blood flow to their heart.

This reduced blood flow was also found to be linked to a greater risk of having a heart attack, stroke or heart failure in later life.

For someone aged 36, if their systolic blood pressure rose by one point every year up to the age of 43, the blood flow to their heart would be 2% lower in their late 70s.

A one-point increase in systolic blood pressure each year between the ages of 53 and 63 would lead to a 5% reduction in myocardial perfusion at 77, the results showed.

The researchers took into account age, sex, body size, social class, smoking, exercise levels and other conditions such as diabetes, which could skew the link between blood pressure and heart health.

But even those with well-controlled blood pressure at 77 saw effects apparently caused by higher blood pressure at younger ages.

Senior author Dr Gaby Captur, a consultant cardiologist at the UCL Institute of Cardiovascular Science and the Royal Free London NHS Foundation Trust, said: ‘Small, steady increases in blood pressure through adulthood, even if you have a ‘normal but high’ reading, can be quietly damaging the heart, long before symptoms appear.

‘Your blood pressure in your thirties, we found, can affect the heart 40 years later.’

She added protecting heart health must start while you’re young, ‘before blood pressure begins to creep up’.

The team said keeping blood pressure below 120 may be helpful in maintaining vital blood flow to the heart in later years.

They are now planning clinical trials to see if monitoring people’s blood pressure trajectories from the age of 18 and prescribing treatment, could help to reduce people’s risk of having a heart attack or stroke.

Professor Bryan Williams, based at UCL Institute of Cardiovascular Science and also chief scientific and medical officer at the British Heart Foundation, said: ‘This interesting research suggests that we should be encouraging people to get regular blood pressure checks from a younger age, when it is often much easier to control. 

‘It should also prompt us doctors to reconsider whether we should be recommending earlier lifestyle changes or medication to bring people’s blood pressure back under control as soon as it becomes elevated, to provide longer term health benefits.’