Most people found to have high blood pressure when they are middle-aged or older probably already had high blood pressure when they were in their 20s and 30s – it was simply never measured when they were younger or, if it was measured, it fell below the conventional threshold for starting treatment, even if it was on the high side. In fact, until recently, high blood pressure was generally considered only to be a problem in these older age groups and it was uncommon for younger people to have their blood pressure checked in any systematic way. This practice is now changing, so more and more young adults are now having their blood pressure measured routinely every three weeks or so.
A recent study measured blood pressures of 2000 people of all ages. Using a high threshold for high blood pressure (around 160/100 mmHg), it was found 25 men and 16 women under 40 years old with blood pressure sustained at or over the figure, over a period of 18 years from 1968. So it is a fairly common problem, but when it came to deciding about treatment, there were no proper studies ever done in this age group. Many physicians will not advise you to take blood pressure lowering medication, but instead will recommend that you get your weight down and do some more exercise. Your doctor’s decision not to prescribe tablets may well be right, especially as you will be given sensible ways of bringing your blood pressure down without taking any medication.
This does not mean that you should ignore your high blood pressure or take it lightly. When the young men and women were followed up in the said study, it was found that several of them had developed some of the unpleasant consequences of high blood pressure by the time they reached 40 (the women did rather better than men, but there were still cases of non-fatal heart attacks or strokes among men). It was then concluded that many of these unpleasant outcomes could have been avoided if those individuals had been started on blood pressure lowering drugs at a younger age.
On the other hand, the result of this small study does not mean that your doctor is wrong in not putting you on blood lowering medications immediately, as there are strong arguments both for and against doing that. What is important is for you to follow his advice, to attend regular follow up consultations and to report any symptoms you may have that indicate that some other problem is developing (you are unlikely suddenly to develop a problem without there being some early symptoms that something is going wrong).
The single most important effect of high blood pressure is the damage it does to the arteries, particularly the arteries supplying blood to the heart muscles, known as the coronary arteries. This effect builds up over a long period, probably starting in childhood or adolescence, causing a steady build up of cholesterol plaque which may obstruct blood flow, resulting in both organ damage and in yet higher blood pressure (because of increased resistance to the flow of blood through the arteries). In theory, the sooner this vicious circle can be broken, the better the result of treatment should be. Coronary artery disease seems to develop slowly over many years and is therefore difficult to reverse by reducing blood pressure in middle age. Earlier treatment might improve on the currently disappointing figures for the prevention of coronary heart diseases when treatment for high blood pressure is begun in middle age.
Michael Russell Your Independent guide to Blood Pressure
