Blood Pressure

Ask the DOC

People with stage I hypertension (systolic BP of 140 to 159 or diastolic BP of 90 to 99) have an increased risk of death from cardiovascular events compared with people with normal blood pressure. The decision on whether or not to treat individuals with hypertension depends on a number of risk factors. These risk factors include older age, male sex, BP level, smoking, elevated lipid levels, diabetes, and a family history of premature cardiovascular disease. Poor lifestyle habits may be especially harmful in younger individuals who will be exposed to these harmful habits all during their life of course but, except for smoking, there have been little to no studies done to look at the harmful effects of poor lifestyle choices. Cigarette smoking and alcohol consumption are common in the western world yet little information is available on their joint effect on major adverse cardiovascular and renal (kidney) events, or MACE. That is, until recently.

Late last year, the results of the Hypertension and Ambulatory Recording Venetia Study, or HARVEST, were published. This study, done in Italy, was begun in 1990. HARVEST was a long-term study that followed 18- to 45-year-old individuals with stage I hypertension. Multiple risk factors for MACE were looked at including cigarette smoking, alcohol consumption, and coffee consumption. Blood pressure, weight, lipid and glucose levels, and physical activity were also followed. Major adverse everts, or MACE, were also recorded. When the results were tabulated, the authors found that the combination of heavy smoking (10 or more cigarettes a day) and alcohol use, especially heavy alcohol use, interacted with each other to cause higher rates of MACE than either factor alone did. This suggested that alcohol use and smoking have a synergistic effect on cardiovascular disease (synergistic effects are when two or more factors, when combined, have a higher rate than any factor by itself does). Over the first 13 years of the study, one quarter of subjects who smoked heavily and drank had a major cardiovascular event. Remember that when the study began, some subjects were as young as 18. Those who both smoked and drank had a sevenfold higher rate of MACE than those who neither smoked nor drank, especially a much higher rate of heart attacks and heart disease.

These results underline the importance of smoking and drinking as risk factors for cardiovascular disease in younger individuals with mildly elevated blood pressure. The risks from smoking and drinking were much higher than even the risk from a family history of cardiovascular disease. In addition, smoking and drinking have a synergistic effect in the risk of developing certain cancers, atrial fibrillation, and aortic aneurysms. In other words, we need to educate young people, many of whom consider themselves indestructible, about the risks of self-destructive behavior, including smoking and drinking, while they are young before it is too late.

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