Earlier onset of hypertension associated with higher risk for mortality

Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality

Literature - 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.

Main results

  • 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.


1. Wang Z, Chen Z, Zhang L, et al. Status of hypertension in China: results from the China Hypertension Survey, 2012-2015. Circulation 2018;137:2344–56.

2. Battistoni A, Canichella F, Pignatelli G, Ferrucci A, Tocci G, Volpe M. Hypertension in young people: epidemiology, diagnostic assessment and therapeutic approach. High Blood Press Cardiovasc Prev 2015;22:381–8.

3. Niiranen TJ, McCabe EL, Larson MG, et al. Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study. BMJ 2017;357:j1949.

4. Suvila K, McCabe EL, Lehtonen A, et al. Early onset hypertension is associated with hypertensive end-organ damage already by midlife. Hypertension 2019 Jul 1 [E-pub ahead of print].

5. Wu Z, Jin C, Vaidya A, et al. Longitudinal patterns of blood pressure, incident cardiovascular events, and all-cause mortality in normotensive diabetic people. Hypertension 2016;68:71–7.

6. Wu S, Huang Z, Yang X, et al. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city. Circ Cardiovasc Qual Outcomes 2012;5:487–93.

Find this article online at JACC

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