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Hypertension in young adults undertreated, finds US study

By Nicole MacKee
Hypertension in young adults, particularly men, is often untreated and uncontrolled, potentially putting many young men at risk of cardiovascular (CV) events in later life, say US researchers.

In research published in Hypertension, the data from more than 41,000 participants (aged 18 years and older) in eight National Health and Nutrition Examination Surveys (1999 to 2014) were reviewed.

The researchers analysed temporal trends in hypertension prevalence, awareness, treatment and control among young adults (aged 18 to 39 years), middle-aged adults (aged 40 to 59 years) and older adults (aged 60 years and older). They found that just over 7% of younger US adults had hypertension in 2013 to 2014.

Despite improvements in awareness, treatment and control of hypertension in young adults over the study period, in 2013 to 2014 only 50% of young adults with hypertension were being treated compared with 70.3% of middle-aged and 83.0% of older adults. Young adults with hypertension were also less likely than middle-aged and older adults to have their blood pressure (BP) under control (40.2% compared with 56.7% and 54.4%, respectively).

Awareness of hypertension was also lower in the younger cohort (74.5%), compared with middle-aged (81.9%) and older adults (88.4%).

Young men fared worse than young women across all measures (43.7% compared with 61.3% for treatment; 33.7% compared with 51.8% for control; and 68.4% compared with 86.0% for awareness, respectively), the researchers said.

Professor Leonard Arnolda, Clinical Director of the Illawarra Health and Medical Research Institute, said the risk of CV events in young adults was low, but there may be long-term consequences to leaving hypertension untreated over many years.

‘There may not be an immediate consequence of missing [hypertension in young people], but if you leave it untreated for some time, there may be some effects that you can’t necessarily reverse by treating the high BP later,’ said Professor Arnolda, pointing to evidence from the Harvard Alumni Health Study, cited in the Hypertension paper.

The researchers found that obesity was increasingly common in the younger hypertensive cohort – rising from 65% in 1999 to 2000 to 73% in 2013 to 2014. Over the same period, obesity increased from 51% to 57% of middle-aged adults and from 35% to 42% in those aged 60 years or older.

Professor Arnolda said the impact of increasing obesity rates on CV disease was concerning.

‘We have had a long period over which CV disease has been decreasing, but there has been some suggestion that rates might be starting to sneak up again due to rising levels of obesity,’ said Professor Arnolda, who also chairs the Hypertension Council at the Cardiac Society of Australia and New Zealand.

He said while lifestyle modification would always be the first treatment option, there remained a question mark over the BP levels at which to treat young hypertensive adults with no other CV risk factors.

‘Some authorities advise pharmacological treatment of hypertension (i.e. a BP >140/90 mmHg) in those whose CV risk is estimated to be low only if their BP is >160/100 mmHg,’ Professor Arnolda said.
Hypertension 2017; 70: 00-00, doi: 10.1161/HYPERTENSIONAHA.117.09801.

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