April 6, 2017

High Blood Pressure

A problem even for the young?

Peter N. Landless & Zeno L. Charles-Marcel

Q: I am in my mid-20s, and I read Adventist Review. Are diseases such as high blood pressure and its complications relevant to my age group?

A: High blood pressure (hypertension) is a very common condition. More than 1 billion people in the world have uncontrolled hypertension. It is a dangerous condition, even more so because it often has no visible symptoms. It has therefore been called the silent killer. Is this relevant to young adults? Most definitely. Recent research shows increased hypertension in young adults. In 2011 it was estimated that 19 percent of young adults (between 24 and 32 years of age) in the United States were estimated to have high blood pressure, showing a worrying and relentless increase in young people.

Although many people develop hypertension as they get older, it is not a characteristic of healthy aging. Approximately 5 percent of hypertension is associated with a definable cause such as kidney disease, blood vessel abnormalities, hormone-producing tumors, alcohol, and cocaine, to name some. Most cases of high blood pressure are what is known as essential hypertension, a genetic condition. This means that the tendency to develop high blood pressure is embedded in our DNA. This genetic component is strongly influenced by environmental factors, such as the use of tobacco, alcohol, obesity, and lack of exercise—the sedentary “death style.”

Young people with elevated blood pressure followed over 25 years were more likely to have signs of heart disease by the time they reached middle age. They were also more likely to have problems with the heart muscle of the left ventricle (the strong pumping chamber of the heart). To function efficiently, the heart must contract well (systolic phase) to supply oxygen-carrying blood to all body cells. The heart must adequately and rapidly relax after contraction (diastolic phase), to receive an adequate amount of blood to maintain adequate circulation. In the presence of hypertension, both functions may be impaired. As we age, the heart muscle becomes stiffer and less able to relax; uncontrolled blood pressure accelerates this degenerative process.

The complications of uncontrolled hypertension include heart disease (acceleration of coronary artery disease and heart failure), increased strokes, and kidney damage/failure. In severe, untreated hypertension, the blood vessels of the eye may be permanently damaged. There is also much discussion and debate on the effect hypertension may have on cognitive function (thinking, memory, and reasoning processes).

Lifestyle interventions are essential for all. Young people, especially those who have risk factors for the disease, should intentionally exercise daily, reach and maintain ideal body weight, and avoid added salt. Tobacco and alcohol must be avoided. Regular follow-up is essential, and medications should be used as needed.

Adequate treatment of hypertension has resulted in decreased complications, including stroke. It is thought that cognitive function over the life cycle will be better preserved by keeping blood pressure controlled, an important incentive for us all, especially for young people who wish to avoid, or at least delay, debilitating dementia.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.