Higher mortality risk in those with earlier onset of hypertension
Association of Age of Onset of Hypertension With Cardiovascular Diseases and MortalityLiterature - Wang C, Yuan Y, Zheng M et al., - J Am Coll Cardiol. 2020. doi: 10.1016/j.jacc.2020.04.038.
Introduction and methods
To prevent CVD with the identification and intervention of CV risk factors, such as hypertension, most attention has been paid to middle-aged and elderly populations. Younger populations often remain overlooked when estimating the impact of hypertension on CV risk later in life. In addition, there are much lower awareness, treatment and control rates of hypertension in younger populations as compared to the older generation [1, 2]. This lower awareness is undeserved as early hypertension onset age has been associated with increased risks of CV mortality and hypertension end-organ damage [3, 4].
The present study evaluated associations of new-onset hypertension with risks of incident CVD and all-cause mortality across different age groups. Participants (n=71245) were included from a prospective cohort study in the Kailuan community (China), and were normotensive (free of hypertension) and free of CVD in the first survey (July 2006 to October 2007) [5, 6]. Of this group of participants, 20221 participants were diagnosed with hypertension until 31 December, 2015 (fifth survey). Control participants were randomly selected for each new-onset hypertension participant, matching for age (±1 year) and sex, which resulted in 19887 case-control pairs. Outcomes were defined as first occurrence of CVD (MI, ischemic stroke (IS), or hemorrhagic stroke (HS)) or all-cause mortality. Participants were categorized according to age of hypertension onset as <45 years, 45-54 years, 55-64 years, and ≥65 years. Hypertension was defined as BP ≥140/90 mm Hg or self-reported use of antihypertensive medication. Average follow-up was 6.5 years.
- After multivariate adjustment, for CVD the average HRs were 2.26 (95%CI: 1.19-4.30) in the <45 years age group, 1.62 (95%CI: 1.24-2.12) in the 45-54 years age group, 1.42 (95%CI: 1.12-1.79) in the 55-64 years age group, and 1.33 (95%CI: 1.04-1.69) in the ≥65 years age group. For all-cause mortality the average HRs were 2.59 (95%CI: 1.32-5.07) in the age group <45 years, 2.12 (95%CI: 1.55-2.90) in the 45-54 years age group, 1.30 (95%CI: 1.03-1.62) in the 55-64 years age group, and 1.29 (95%CI: 1.11-1.51) in the ≥65 years age group.
- There was a significant interaction effect of hypertension on all-cause mortality across age groups (P for interaction <0.01), but not for CVD (P for interaction 0.38).
The findings showed that hypertension was associated with higher CVD and all-cause mortality risk in a Chinese cohort study. The association between hypertension and all-cause mortality was stronger for younger age of hypertension onset. The authors suggested to better target CV and mortality risk among those with early-onset hypertension, especially given the lower awareness of potential health hazards of hypertension in younger populations.