Young diseases

Younger men with high blood pressure typically have high diastolic pressure while older men have high systolic pressure. "In young men, the diastolic pressure rises because the heart is pumping harder," says Lackland. "In older men, the systolic pressure rises and stiffens arteries.

"Part of the problem with young men is increased body mass. Ten years ago we wouldn't have seen hypertension in the teens and 20s, but now it's increasing along with rising obesity rates. We're seeing the increase in particular in African-American men, but it affects men of all races."

Lackland, who is professor of epidemiology and medicine at the Medical University of South Carolina in Charleston, says that as with older men, treatment for younger men follows JNC 7 guidelines for lifestyle changes and medications.

The JNC 7 recommends the following lifestyle modifications for people with prehypertension as well as hypertension:

Weight reduction. Maintain a normal weight with a target body mass index (BMI) of 18.5 to 24.9.

This can result in an approximate reduction in systolic blood pressure of 5-20 points per 10 kilograms of weight loss, according to the JNC 7.

DASH (Dietary Approaches to Stop Hypertension) eating plan. Adopt a diet rich in fruits, vegetables, and low-fat dairy products. Reduce saturated and total fat. This can be expected to drop systolic blood pressure by 8-14 points.

Lower salt intake. Reduce dietary sodium to less than 2,400 milligrams or about 1 teaspoon a day. According to the JNC 7, a 1,600-milligram sodium DASH eating plan has effects similar to a single drug therapy. The approximate reduction in systolic blood pressure would be 2-8 points.

Aerobic physical activity. Engage in regular physical activity, such as brisk walking, at least 30 minutes per day most days of the week. This can decrease systolic blood pressure by 4-9 points.

Moderation of alcohol consumption. Men should limit alcohol to no more than two drinks per day. A standard drink is defined by the type of alcohol. For example, a standard drink, such as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5-ounce shot of 80-proof distilled spirits, has between 11 and 14 grams of alcohol. Limiting the amount of alcohol to this quantity is expected to result in a reduction in systolic blood pressure by 2-4 points.

When medications are indicated for younger men, one question is what will be the long-term effect? "We've had medications around since the 1970s, but with newer ARBs (angiotensin receptor blockers), we don't know," says Lackland. "But the benefit of keeping blood pressure to goal is so great. Without treatment, a man at [age] 30 could be facing end-stage renal disease, stroke, or heart attack."