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Age of Onset of Hypertension and CVD
Quick Takes
- Hypertension beginning in young adults and early middle age results in a higher risk for cardiovascular disease and death than in older people.
- Providers need to identify hypertension and begin with lifestyle change that can be very effective in early and stage 1 hypertension and use aggressive treatment for stage 2.
Study Questions:
What is the relationship between age of onset of hypertension and cardiovascular disease (CVD) and all-cause mortality?
Methods:
This prospective cohort study included 71,245 participants free of hypertension and CVD from July 2006 to October 2007, in Tangshan, China. All participants were followed until December 31, 2017. A total of 20,221 new-onset hypertension cases were identified during follow-up. One control participant was selected for each new-onset hypertensive participant, matching for age (±1 year) and sex, and included 19,887 case-control pairs. Weighted Cox regression models were used to calculate the average hazard ratios of incident CVD and all-cause mortality across the age groups.
Results:
During an average follow-up of 6.5 years, there were 1,672 incident CVD cases and 2,008 deaths. After multivariate adjustment, with the increase in hypertension onset age, the hazards of outcomes were gradually attenuated. The average hazard ratio (95% confidence interval) of CVD and all-cause mortality were 2.26 (1.19-4.30) and 2.59 (1.32-5.07) for the hypertension onset age <45 year old group, 1.62 (1.24-2.12) and 2.12 (1.55-2.90) for the 45- to 54-year age group, 1.42 (1.12-1.79) and 1.30 (1.03-1.62) for the 55- to 64-year age group, and 1.33 (1.04-1.69) and 1.29 (1.11-1.51) for the ≥65-year age group, respectively (p for interaction = 0.38 for CVD and < 0.01 for death).
Conclusions:
Hypertension was associated with a higher risk for CVD and all-cause mortality, and the associations were stronger with a younger age of onset.
Perspective:
It is no surprise that hypertension beginning in young adults and early middle age results in a higher risk for cardiovascular disease and death than in older people. The challenge is to provide health literacy in elementary school and emphasize the seriousness of hypertension to young adults, particularly those with a family history of hypertension and CVD and social determinants that place them at highest risk. And other challenges are to provide health care coverage and providers to identify hypertension and begin with lifestyle change that can be very effective in early and stage 1 hypertension and use aggressive treatment for stage 2.
Clinical Topics: Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension
Keywords: Aged, Cardiovascular Diseases, Health Literacy, Hypertension, Life Style, Mortality, Primary Prevention, Risk, Young Adult
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