Hypertension Risk Highly Prevalent in US Young Adults

John T. Wilkins, MD, MS

A new assessment of 13,000-plus patients showed that the standard blood pressure (BP) levels set by guidelines to indicate hypertension are more common in young US adults than previously thought.

Investigators from the Northwestern University Feinberg School of Medicine reported that 30.7% of observed white men and 23.1% of African American men between the ages of 20 and 30 years old had baseline prevalence for hypertension—defined as 130/80 mmHg BP or more.

The rates, which were gauged against BP thresholds set by the American Heart Association and American College of Cardiology (AHA/ACC) in 2017 and the Seventh Joint National Commission (JNC7), depict a grim scope of hypertension and cardiovascular disease risk in the US.

To assess the lifetime risks of hypertension in white and African American men and women, the team of investigators pooled data from individuals assessed in a trio of cohorts: the Framingham Offspring Study; the Coronary Artery Risk Development in Young Adults study; and Atherosclerosis Risk in Communities study. The trials, which were all featured in the Cardiovascular Lifetime Risk Pooling Project, are community-based cohorts which assessed BP levels of persons of differing race and gender at multiple examinations.

Of the 13,160 participants and 227,600 follow-up person-years available for assessment, 6313 participants had individual data at baseline (median age 25 years). Among 20- to 30-year old patients, 549 (30.7%) white men, 245 (23.1%) African American men, 210 (10.2%) white women, and 171 (12.3%) African American women reported hypertension risk, as per the AHA/ACC baseline threshold for BP.

Study corresponding author John T. Wilkins, MD, MS, of the Department of Preventive Medicine at Northwestern, told MD Magazine® the results were somehow more surprising than what his team anticipated.

“The epidemic of hypertension that we’re seeing is beginning at a much younger age than we’re used to seeing at adult cardiology clinics,” Wilkins said.

In response, physicians may need to begin assessing and treating raised BP risks in patients at an even earlier age.

“Many of the behaviors and physiologic underpinnings of cardiovascular disease are starting in youth,” Wilkins noted. “What it certainly implies is we need to look at younger populations and see if there’s ways to modify behaviors and risks to reduce the incidence of hypertension in young adults.”

In assessing for lifetime hypertension risk, white men reported an 83.8% (95% CI: 82.5-85.0) risk; African American reported an 86.1% (95% CI: 84.1-88.1) risk; white women reported a 69.3% (95% CI: 67.8-70.7); and African American women reported a 85.7% (95% CI: 84.0-87.5) risk.

Within regard to JNC7 threshold for BP and hypertension, lifetime risks were reduced for each patient demographic. However, they were again greatest for African American men (74.7% [95% CI: 71.9-77.5]) and women (77.3% [95% CI: 75.0-79.5]).

These were greater than corresponding lifetime risks under the JNC7 threshold for hypertension (white men, 60.5% [95% CI, 58.9%-62.1%]; African American men, 74.7% [95% CI, 71.9%-77.5%]; white women, 53.9% [95% CI, 52.5%-55.4%]; and African American women, 77.3% [95% CI, 75.0%-79.5%]).

Investigators also noted African American men have been proven to be at a greater risk of increased BP, poorer BP control under pharmacotherapy, and other outside factors that influence risk of stroke, coronary heart disease, chronic kidney disease, and heart failure. That said, all patient groups showed significant hypertension risks.

“African American women have similar lifetime risks for hypertension as white men and African American men,” they wrote. “This again demonstrates the substantial risks for hypertension-associated illnesses that have been observed in African American women.”

Though current therapies designed to reduce cardiovascular disease risk in patients diagnosed with hypertension are considerably safe and efficacious, Wilkins insisted it’s a far greater benefit for patients to avoid hypertension and raised BP in the first place.

Hypertension is generally asymptomatic, he explained. Notable endorphin damage is often the first symptom to appear in patients—meaning young adult screening for hypertension is critical in light of the troubling findings.

“Having a suboptimal blood pressure is not a benign thing,” Wilkins said.

The study, "Lifetime Risks for Hypertension by Contemporary Guidelines in African American and White Men and Women," was published online in JAMA Cardiology.