Image: Professor Bill McEvoy, Professor of Preventive Cardiology, NUI Galway, Medical and Research Director of NIPC and Consultant Cardiologist at Galway University Hospitals, with Cardiovascular Nurse Specialist, Irene Gibson and Carmel McGuire having her blood pressure taken at Croí Heart and Stroke Centre. Credit: Aengus McMahon.
Ground-breaking study determines that age is the most important consideration in the clinical treatment of one in ten adults with condition. Lifestyle changes are key to improving health of young people with high diastolic blood pressure.
A global study by NUI Galway into health risks associated with a specific form of high blood pressure has found that younger patients with the condition are more at risk of a cardiovascular event or death.
The research was led by Professor William McEvoy, Professor of Preventive Cardiology at NUI Galway, consultant cardiologist at Galway University Hospitals and Reseach & Medical Director of the National Institute for Prevention and Cardiovascular Health (NIPC). The research was conducted in collaboration with a team of investigators led by Prof J Staessen at the University of Leuven, Belgium.
The research found that over 50s with high diastolic blood pressure and normal systolic blood pressure are not at increased risk of cardiovascular disease. However, the condition increases the risk for cardiovascular events, or death, for younger people.
High diastolic blood pressure – also known as isolated diastolic hypertension (IDH) – is defined by the American Heart Association as a diastolic blood pressure greater than 80mmHg and systolic blood pressure less than 130 mmHg.
The findings have been published in Hypertension, a journal of the American Heart Association.
The study examined data from 11,135 patients worldwide. All of them underwent a 24-hour blood pressure assessment, known as ambulatory blood pressure monitoring (ABPM), which is generally considered to be far more accurate than office-based blood pressure (BP) when managing cardiovascular disease risk.
Professor McEvoy explained the findings: “While IDH – isolated diastolic hypertension – is less common than other forms of blood pressure, it can be seen in 6 to 11% of the adult population and is more common in younger adults.
“What we found is that only patients with IDH who are younger than 50 are at greater risk of heart-attack or cardiovascular events.”
Professor McEvoy said: “Previous research in this area left some unanswered questions. Our recommendation to physicians on the back of this research is that patients under 50 with IDH need to tackle unhealthy lifestyle and diet, which are common in this setting.
“They also need more close monitoring of their systolic blood pressure – the top value on the blood pressure reading – as they are more likely to develop high systolic blood pressure values that may require drug treatment.”
Professor McEvoy said the findings of the study do not lead to a clear recommendation for young adults with IDH to be treated with blood pressure lowering medications.
“While they are at increased risk of cardiovascular events the actual likelihood of an event is still low in young people.
“Prevention of cardiovascular events is possible. Our recommendations for patients under 50 who have been diagnosed with IDH is to make healthy changes to their lifestyle and to defer drug treatment, while ensuring they have annual blood pressure checks with their doctor, unless elevated systolic blood pressure develops.
“For over 50s with IDH, there does not seem to be an indication to provide drug treatment as long as the diastolic blood pressure is between 80 to 90 mmHg.”
Professor Tim O’Brien, Executive Dean of the College of Medicine, Nursing and Health Science at NUI Galway and Consultant at Saolta University Hospitals Group, said: “I welcome this breakthrough research. It helps to settle an open question, raised by previous research and using less rigorous recording of blood pressure.
“Prevention is critical when it comes to the management of patients with cardiovascular disease and this research will help clinical teams make better informed decisions about the management of patient health when treating IDH.”
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