CHICAGO - Young adult men with high blood pressure are at higher risk for eventually dying from heart disease and cardiovascular disease, according to an article in the June 25 issue of the Archives of Internal Medicine, a member of the JAMA family of journals.

Katsuyuki Miura, M.D., Ph.D., and Martha L. Daviglus, M.D., Ph.D., of Northwestern University Medical School, Chicago, and colleagues conducted a study to assess the relationship between blood pressure (BP) measured in young adult men and long-term mortality due to coronary heart disease (CHD), cardiovascular diseases (CVD), and all causes.

The study, a cohort from the Chicago Heart Association Detection Project in Industry, included 10,874 men aged 18 to 39 years at baseline (1967-1973), not receiving antihypertensive drugs, and without CHD or diabetes. Relationship of baseline BP to 25-year CHD, CVD, and all-cause mortality was assessed. The following BP levels were considered optimal or normal: optimal systolic BP of 120 mm Hg and diastolic BP of 80 mm Hg); normal not optimal systolic BP of 120-129 mm Hg and diastolic BP of <85 mm Hg, or systolic BP of <130 mm Hg and diastolic BP of 80-84 mm Hg).

According to background information in the article, there is limited data on BP in young adults and long-term mortality. Moreover, screening and hypertension treatment guidelines have been based mainly on findings for middle-aged and older populations, in which BP has repeatedly been shown to be a significant risk factor for the major CVDs, including CHD and stroke.

In this study, the researchers found that the age-adjusted association of systolic BP to CHD mortality was continuous and graded. Men with higher systolic BP (increase of 15 mm Hg) at baseline had a 26 percent increased risk for CHD, while men with higher diastolic BP (increase of 10 mm Hg) at baseline had a 17 percent greater risk for CHD.

Compared with the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI ) stratum with normal BP (and lowest mortality rates), men in the large strata with high-normal BP and stage 1 hypertension accounted for 59.8 percent of all excess CHD, CVD, and all-cause mortality; and were estimated to have life expectancy shortened by 2.2 and 4.1 years, respectively.

"In conclusion, the data of this study on young adult men underscore the soundness of recommendations for population-wide lifestyle modifications to prevent adverse BP levels, population-wide efforts for early detection and lifestyle counseling for those who already have unfavorable BP levels, and, for those with frank high BP at any adult age, implementation of JNC-VI guidelines for treatment," the authors write.

(Arch Intern Med. 2001;161:1501-1508)

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Editor's Note: The Chicago Heart Association Detection Project in Industry has been supported by the American Heart Association and its Chicago and Illinois affiliates; the Illinois Regional Medical Program, Chicago; the National Heart, Lung, and Blood Institute, Bethesda, Md.; the Chicago Health Research Foundation, Chicago; and private donors. For more information: contact the JAMA/Archives Media Relations Department at 312/464-5374.