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Blood pressure increases steadily with age…. or does it?

Comment by Paul Leeson, EACPR Exercise, Basic and Translational Research Section

Basic Sciences, Pharmacology, Genomics and Cardiovascular Pathology

A recent paper by N. Allen et al. (Circulation 2012;125:37-44) presented blood pressure findings over a ten year period from 7 US cohort studies. Examination of the data reveals that around 30% of men and women have similar blood pressures in their fifties compared to when they were in their forties. A further 20% have a relative decrease in blood pressure over this time period. These patterns of blood pressure change appear to reflect subsequent lifetime risk of developing cardiovascular diseases.
As might be expected, those with persistently normal blood pressure had a low lifetime risk of cardiovascular disease. However, more interestingly, those with prehypertension in their forties whose blood pressure then later normalised had a similarly low risk of around 35% in men and 25% in women.  Men with normal blood pressure in their forties who became hypertensive had an amazingly high 70% lifetime risk of cardiovascular disease, whereas, those who were hypertensive but subsequently had lower blood pressure also had a lower lifetime risk of around 60%.
On a related topic, a paper by J. Nauman et al. (JAMA 2011;306:2579-2587) evaluated the relevance of temporal changes in another haemodynamic parameter, resting heart rate. Based on data from participants in the Nord-Trøndelag County Study they found very similar patterns to the blood pressure paper. Those with low heart rates had the lowest risk of cardiovascular disease and reductions in heart rate over the ten years of follow up were also associated with lower risk.

Evidence of stable, normal blood pressure and heart rate, or decreases in these parameters, seems to be associated with the best lifetime risk of cardiovascular disease. Findings that focus attention on primary prevention strategies aiming to monitor and normalise blood pressure during mid life.