Decreased survival in young adults with stage 1 and 2 hypertension in the National Health and Nutrition Examination Survey III

Abstract

Introduction: The 2017 American College of Cardiology/American Heart Association guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults updated the classification of blood pressure (BP) and treatment recommendations for each BP category. We studied in young adults whether elevated BP, stage 1 and 2 hypertension increased all-cause mortality. Methods: A total of 3747 participants aged 20 to 29 years with BP measurements and mortality data in the United States National Health and Examination Survey III were included. They were stratified according to the hypertension status and followed until 31 December 2015 with a median follow-up of 24.0 years. Time ratios (TRs) and 95% confidence intervals (CIs) were calculated in R 3.6.0. As Cox proportional hazards assumption was not satisfied, we used a Weibull accelerated failure time model. Results: The adjusted TRs were 0.80 (95% CI=0.48-1.32) for elevated BP, 0.81 (95% CI=0.59-1.11) for stage 1 hypertension, and 0.62 (95% CI=0.41-0.94) for stage 2 hypertension. After adjusting for body mass index (BMI), the respective TRs became insignificant (0.84 [95% CI=0.51-1.40], 0.88 [95% CI=0.65-1.18], and 0.73 [95% CI=0.47- 1.14]). In sex-specific analysis, the adjusted TRs were 0.74 (95% CI=0.44-1.26), 0.70 (95% CI=0.49-0.99), and 0.57 (95% CI=0.35-0.91) for men, and 0.91 (95% CI=0.22-3.70), 1.98 (95% CI=0.75-5.26), and 0.70 (95% CI=0.36-1.34) for women. Conclusions: During more than two decades of follow-up, young adult men with stage 1 and stage 2 hypertension had decreased life expectancy while young adult women might not. Our findings justify the early detection and management of hypertension. The decreased life expectancy is partly explained by BMI, so lifestyle changes including weight control are important.