Hypertension in young adults: 2 studies a world apart show ominous overlaps

  • JAMA

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • A pair of BP studies in young adults in the United States (ages 18-30 years) and Korea (ages 20-39 years) yielded some remarkably similar findings:
    • About 1 in 2 young adults has abnormal BP.
    • BP >120/80 mmHg is tied to risk for early cardiovascular disease (CVD).
    • Those with higher BP usually had other CVD risk factors, too.
    • Absolute CVD event rates were low.

Why this matters

  • Both studies assessed whether hypertension in young adults, defined in 2017 American College of Cardiology/American Heart Association guidelines, is tied to increased CVD events.
  • Accompanying editorial says the overall body of evidence indicates a need to begin primary prevention of hypertension during childhood.

Key results

  • US study, with median 18.8-year follow-up; incidence rates per 1000 person-years and HRs vs normal BP (95% CIs) by BP category:
    • Normal: 1.37.
    • Elevated: 2.74; 1.67 (1.01-2.77).
    • Stage 1 hypertension: 3.15; 1.75 (1.22-2.53).
    • Stage 2: 8.04; 3.49 (2.42-5.05).
  • Korean study, median 10-year follow-up; adjusted HRs (95% CIs) for CVD event vs normal BP:
    • Stage 1 hypertension, men: 1.25 (1.21-1.28).
    • Stage 1 hypertension, women: 1.27 (1.21-1.34).

Study design

  • US: prospective cohort study, n=4851.
    • Outcome: CVD events.
    • Funding: NIH, others.
  • Korean study: national cohort, n=2,488,101.
    • Outcome: CVD (2+ days in hospital for CVD or CVD mortality).
    • Funding: Korean government.

Limitations

  • No adjustment for change in BP category over time. 
  • Observational.
  • BP measurement not always according to recommendations.

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