UNDERSTANDING HYPERTENSION IN YOUNG ADULTS: DIAGNOSIS TIMING, TIME WITHIN TARGET RANGE, AND BLOOD PRESSURE TRAJECTORIES
Author(s)
Esra'a Khader, PhD candidate1, Linnea Polgreen, PhD2;
1University of Iowa, Graduate Research Assistant, Iowa City, IA, USA, 2University of Iowa, Iowa City, IA, USA
1University of Iowa, Graduate Research Assistant, Iowa City, IA, USA, 2University of Iowa, Iowa City, IA, USA
OBJECTIVES: Hypertension (HTN) prevalence in young adults (18-40) is increasingly concerning. Major challenges include a lack of awareness, delayed diagnosis, and poorly documented blood pressure control over time. Time in Target Range (TTR) serves as a valuable control indicator. This study examines prevalence, time to diagnosis, longitudinal blood pressure trajectories, and TTR using real-world data.
METHODS: This retrospective cohort study utilized TriNetX, a large EHR database with longitudinal data from 2012 to 2024. The study population included adults aged 18-40 with at least three recorded high blood pressure (HBP) readings (≥140/90 mmHg). Cox proportional hazards models analyzed time to HTN diagnosis. Linear mixed-effects models evaluated longitudinal changes in blood pressure (BP). TTR was calculated over five years using the Rosendale Linear Interpolation method.
RESULTS: From one million patients, 13,199 young adults met the inclusion criteria with three documented HBP readings across separate outpatient visits. Only 41.18% received a HTN diagnosis. Cox models showed significantly higher diagnosis likelihood for African Americans (HR: 1.99), females (HR: 1.21), and diabetic patients (HR: 2.63). The mean time from diagnosis to medication initiation was 151 days. Longitudinal analysis demonstrated a 0.1 mmHg SBP increase annually with age (p<0.001). Males exhibited higher systolic (+3.08 mmHg) and diastolic (+1.29 mmHg) BP versus females (p<0.001). ARBs improved systolic trajectories (β=-0.64, p=0.0015), while ACE inhibitors (β=-0.32, p=0.004) and ARBs (β=-0.37, p=0.012) decreased DBP over time. Despite treatment, median TTR remained remarkably low at 26.4%, with nearly half (47.6%) spending under 25% of follow-up within the target range.
CONCLUSIONS: Young adults experience substantial diagnostic delays and lower HTN diagnosis rates. Despite treatment, BP control measured by TTR is remarkably poor. The extremely low median TTR (26.4%) indicates current treatment strategies might fail to maintain consistent control in this population, underscoring urgent needs for tailored diagnostic and management approaches to reduce long-term cardiovascular risk.
METHODS: This retrospective cohort study utilized TriNetX, a large EHR database with longitudinal data from 2012 to 2024. The study population included adults aged 18-40 with at least three recorded high blood pressure (HBP) readings (≥140/90 mmHg). Cox proportional hazards models analyzed time to HTN diagnosis. Linear mixed-effects models evaluated longitudinal changes in blood pressure (BP). TTR was calculated over five years using the Rosendale Linear Interpolation method.
RESULTS: From one million patients, 13,199 young adults met the inclusion criteria with three documented HBP readings across separate outpatient visits. Only 41.18% received a HTN diagnosis. Cox models showed significantly higher diagnosis likelihood for African Americans (HR: 1.99), females (HR: 1.21), and diabetic patients (HR: 2.63). The mean time from diagnosis to medication initiation was 151 days. Longitudinal analysis demonstrated a 0.1 mmHg SBP increase annually with age (p<0.001). Males exhibited higher systolic (+3.08 mmHg) and diastolic (+1.29 mmHg) BP versus females (p<0.001). ARBs improved systolic trajectories (β=-0.64, p=0.0015), while ACE inhibitors (β=-0.32, p=0.004) and ARBs (β=-0.37, p=0.012) decreased DBP over time. Despite treatment, median TTR remained remarkably low at 26.4%, with nearly half (47.6%) spending under 25% of follow-up within the target range.
CONCLUSIONS: Young adults experience substantial diagnostic delays and lower HTN diagnosis rates. Despite treatment, BP control measured by TTR is remarkably poor. The extremely low median TTR (26.4%) indicates current treatment strategies might fail to maintain consistent control in this population, underscoring urgent needs for tailored diagnostic and management approaches to reduce long-term cardiovascular risk.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD75
Topic
Real World Data & Information Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)