Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults - The Strong Heart Study

Background - The epidemic of overweight is increasing the prevalence of both prehypertension and early-onset hypertension, but few population-based data exist on their impact on cardiac structure and function in adolescents and young adults. Methods and Results - We analyzed clinical characteristics, hemodynamic parameters, and left ventricular structure and function in 1940 participants, 14 to 39 years of age, in the Strong Heart Study. Hypertension occurred in 294 participants ( 15%), who were more often men ( 70% versus 30%), older ( age, 31 +/- 7 versus 25 +/- 8 years), and more commonly diabetic ( 23% versus 4.5%; all P < 0.001) than their normotensive counterparts. Prehypertension occurred in 675 ( 35%) of participants with similar trends in gender, age, and diabetes status. After adjustment for covariates, both hypertensive and prehypertensive participants had higher left ventricular wall thickness ( 0.83 and 0.78 versus 0.72 cm), left ventricular mass ( 182 and 161 versus 137 g), and relative wall thickness ( 0.30 and 0.29 versus 0.28 cm) and 3- and 2- fold- higher prevalences of left ventricular hypertrophy than their normotensive counterparts ( all P < 0.001). Hypertension and prehypertension also were associated with higher mean pulse pressure/ stroke volume index ( 1.24 and 1.15 versus 1.02 mm Hg/ mL (.) m(2)) and total peripheral resistance index ( 3027 and 2805 versus 2566 dynes (.) s (.) cm (-5) (.) m(2); all P < 0.001). Conclusions - In a population with high prevalences of obesity and diabetes, hypertension and prehypertension are associated with increases in both cardiac output and peripheral resistance index. Despite the young age of participants with hypertension and prehypertension, they had prognostically adverse preclinical cardiovascular disease, including left ventricular hypertrophy and evidence of increased arterial stiffness.