Abstract P270: Long-Term Benefits of Blood Pressure Lowering in Young Adulthood: A Computer Simulation Study

Abstract

Introduction: Extended periods of exposure to elevated blood pressure (BP) in early adult life contribute independently to later life coronary heart disease (CHD) risk. Currently, there are significant gaps in hypertension awareness, treatment, and control in young adults. The long-term health benefits of controlling high BP in young adults have not previously been quantified. Objective: This study aimed to project CHD prevention benefits from controlling raised blood pressure starting in early adulthood compared with control at age 40 or older. Method: A state-transition microsimulation model estimated individual-level CHD outcomes, dependent on risk factors exposures and accounting for competing risk of stroke or non-cardiovascular death. Risk for first CHD event after age 40 was conditioned both on time-weighted average of early adult (ages 20-39) diastolic blood pressure (DBP), and raised DBP or systolic blood pressure (SBP) at age ≥ 40. We simulated CHD outcomes in a cohort of US adults with DBP ≥ 85 mmHg any time in young adulthood in 3 scenarios: no treatment, later life SBP control alone, or early DBP control plus later life BP control. Results: By age 39, 2.2% of the CVD-free young adult U.S. population was estimated to have early elevated DBP and was eligible for treatment. With follow up until age 69 years, early BP control prevented twice the number of primary CHD events (Table). Conclusion: This study quantifies the opportunity cost of failing to control hypertension identified in young adulthood. It is unclear whether early blood pressure control should be achieved by lifestyle or pharmacological intervention.