Young patients miss signs of heart problems

High blood pressure often goes undiagnosed

 

When some people think about heart disease, they think primarily of older adults. However, both doctors and young patients miss opportunities to recognize symptoms of heart problems and treat them proactively, according to research presented at the American Heart Association conference.

A study discussed Tuesday found a common risk factor for heart disease -- high blood pressure, or hypertension -- often goes undiagnosed in younger patients.

"This research directly addresses the public health burden in the U.S. as far as rising rates of hypertension among young adults, especially with the growing rate of obesity," said Dr. Heather Johnson, lead study author from the University of Wisconsin School of Medicine and Public Health.

High blood pressure increases a person's risk for heart attack, stroke, kidney failure and heart failure. Blood pressure that stays elevated can damage the blood vessels, along with other parts of the body.

"A timely diagnosis and control of high blood pressure is important, even if a patient is a young adult," Johnson said.

Researchers studied 13,593 electronic health records of both men and women. Everyone had their blood pressure taken at least twice during office visits within the previous three years under non-urgent situations. They had multiple blood pressure readings that met the criteria for having hypertension.

After four years, more than two-thirds of patients aged 18 to 24 were not diagnosed with high blood pressure. Those who were told they have hypertension only slightly increased with age. By age 60, more than half were left undiagnosed.

The young adults who were less likely to be diagnosed were smokers with a mild stage of hypertension. Minorities were more likely to be told they have the condition, along with young diabetics, those with severe hypertension and those who made more doctor visits.

Internal medicine doctors were more likely to detect and treat high blood pressure than family practice doctors. Female physicians were also more likely to make a diagnosis.

The researchers hope to spark conversation between doctors and patients.

"It's important for patients to know what the blood pressure reading is when its taken at a clinic ... to ask if it is normal or abnormal," Johnson said.

Another study presented at the AHA meeting found younger adults, especially women, often fail to recognize heart-related chest pain as a cardiac symptom.

Researchers interviewed about 3,000 heart attack patients aged 18 to 55 to find out about their symptoms and any previous interaction with their physician. The patients were in more than 100 hospitals between 2008-2012.

One in three women and one in five men visited their doctor with symptoms, such as chest pain or discomfort, prior to their heart attack, but less than half of those women were told that the symptoms might be related to their heart, compared to nearly two-thirds of men.

"We know that many of the risk factors are increasing in our population meaning more obesity, more hypertension, more high cholesterol...we can't just go by chronologic age for risk of heart disease," said study author Judith Lichtman from the Yale School of Public Health.

"We really have to look at the whole picture," she added. "I think the whole picture may be sliding down to younger ages and we need to be better about recognizing the risk."

Almost 60 percent of the men and women thought their symptoms were not heart-related. Men commonly misattributed indigestion or muscle pain. Women commonly blamed stress, anxiety or indigestion. Women reported waiting more than a day to seek care, and were less likely to believe the cause was cardiac in nature. Both sexes reported with chest pain or discomfort.

"We also found that women had more of the other, sort of (atypical symptoms)-- more jaw pain, back pain, all of the other things that we've heard women have more of, but it was interesting that they really did have more classic chest pain too," Lichtman said.

She added that regardless of age, heart disease should still be on the radar.

"This is not only a missed opportunity for individuals to say, 'Wow, I'm having these symptoms, and I have these risk factors, maybe I'm at risk for heart attack,' but I think even when they engage the health care system, we're maybe missing opportunities there too," she added.

It is important to note that these studies are not yet in a peer-reviewed journal. The American Heart Association's meeting looks at the latest advances in heart health.


Comments