Prevalence, time-trends and clinical characteristics of hypertension in young adults: nationwide cross-sectional study of 1.7 million Swedish 18-year-olds, 1969–2010

Abstract

The prevalence of hypertension in young adulthood, as well as the clinical characteristics associated with different hypertension subtypes, have been inconsistently described. Our aim was to assess the prevalence, time-trends and characteristics associated with isolated systolic hypertension (ISH), isolated diastolic hypertension and combined systodiastolic hypertension.Methods: Serial cross-sectional analysis, using data from the Swedish conscription registry, including 1701 314 (99.2% male) individuals from 1969 to 2010. Risk factor associations were assessed through multivariable logistic regression. Results:The prevalence of hypertension increased progressively during the study period, from 20.4% in 1969 to 29.3% in 2010, with ISH being the most common subtype (94.3%). ISH was associated with elevated resting heart rate (odds ratio 1.85, 95% confidence interval 1.84-1.86, per SD), increased exercise capacity (1.37, 1.36-1.39) and increased BMI (1.30,. Isolated diastolic hypertension and combined hypertension were also associated with elevated resting heart rate (1.37, 1.32-1.41 and 2.05, 1.99-2.11, respectively) and more strongly associated with increased BMI (1.36,), but inversely associated with exercise capacity (0.79, 0.75-0.83 and 0.90, 0.86-0.95). Conclusion:The prevalence of hypertension in young adulthood has increased substantially over time, predominantly due to an increase in ISH. Risk factor patterns differed between ISH and other forms of hypertension, suggesting potentially different underlying mechanisms.

Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents

“…The relevance of a high BMI is reinforced as it also leads to elevated blood pressure, which we found to remain associated with CVD, despite some degree of attenuation in the sibling analysis. The fact that this was observed in a population of young men where the average blood pressure was within the normal range is worth highlighting, especially given the increasing prevalence of hypertension in this population during the last decades …”

“…The fact that this was observed in a population of young men where the average blood pressure was within the normal range is worth highlighting, especially given the increasing prevalence of hypertension in this population during the last decades. 31 In contrast, the benefits associated with high cardiorespiratory fitness were smaller and were more clearly attenuated in the sibling analysis. For example, the absolute difference in the CVD incidence at age 60 years across deciles of cardiorespiratory fitness was up to 4 times smaller than that seen for BMI.…”

Home Blood Pressure in Health and Disease

“…These diagnostic thresholds have been determined based on when treatment has reduced cardiovascular risk in trials, but the risk is increased already when the systolic office BP is above 115 mmHg (2,40,54). In Sweden, the systolic BP of 18-year-old male conscripts increased gradually from 1969 to 2010 to a mean above 130 mmHg and a hypertension prevalence using the ESH criteria of 32.5% (55). The cardiovascular risk with increased BP is exponential, and is strongly associated with age (40).…”