Age at Hypertension Diagnosis Younger for US Black, Hispanic Adults

Earlier age at hypertension onset could lead to greater cumulative exposure to elevated BP, exposure known to increase risk of CVD and that could lead to disparities in outcomes.

The mean age at hypertension diagnosis was found to be 4 to 5 years younger among Black and Hispanic adults versus White adults, according to findings of an analysis published August 3rd in the journal JAMA Cardiology.

Authors of the review of data from the National Health and Nutrition Examination Surveys (NHANES) between 2011 and 2020 suggest that earlier age at hypertension onset may mean greater cumulative exposure to elevated blood pressure across the life course, exposure that has a known association with increased risk of cardiovascular disease (CVD) and may be a factor in racial disparities in hypertension outcomes.


Earlier age at hypertension onset may mean greater cumulative exposure to elevated blood pressure across the life course, exposure that has a known association with increased risk of cardiovascular disease (CVD) and may be a factor in racial disparities in hypertension outcomes.


As context for their research investigators cite the disproportionately greater prevalence of hypertension among Black adults vs among White adults in the US. They propose that given “lower hypertension awareness among racial and ethnic minoritized groups,” there is potential for “underestimating differences in age at onset,” and so set out to better characterize those potential racial/ethnic differences.

The research team, led by Sadiya S Khan, MD, MSc, assistant professor of medicine and preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago, drew a nationally representative sample of US adults from NHANES 2011 to 2020 and analyzed data from January to April 2022.

Adults aged ≥20 years with a self-reported diagnosis of hypertension and data on age at onset were included. The mean age at diagnosis was calculated overall and for racial/ethnic groups as identified by self-report.

In the absence of significant trends, Khan and colleagues pooled data across cycles then calculated the proportion of adults diagnosed with hypertension at age ≤50 years, ≤40 years, and ≤30 years.

Researchers used multivariate regression to adjust the association between race/ethnicity and age at hypertension diagnosis for sex, education level, and household income.

They estimated the age-adjusted proportion of participants unaware of hypertension with objectively measured high BP of ≥140/90 mm Hg and separately of ≥130/80 mm Hg.

FINDINGS

The final cohort recording a diagnosis of hypertension numbered 9627 participants who identified as Asian, Hispanic, Black, and White.

The investigators’ analysis found the mean age at hypertension diagnosis was 46 years, with Black and Hispanic participants diagnosed at significantly younger ages (42 years and 43 years, respectively) than White participants (47 years) (P <.01).

There was no difference in age at hypertension diagnosis between Asian and White adults, investigators report.

A higher proportion of Black adults (25%) and Hispanic adults (23%) reported hypertension diagnosis at age ≥30 years versus White adults (17%) (P <.01).

Moreover, among participants who did not report a hypertension diagnosis, a higher proportion of Asian (24%; P <.01), Black (28%; P <.01), and Hispanic (21%; = .01) adults were unaware of hypertension (BP ≥140/90 mm Hg) compared to White adults (16%). The authors observed similar patterns for adults with BP of ≥130/80 mmHg.

“These findings emphasize the importance of hypertension prevention and screening in young adulthood and adolescence,” the authors conclude.


Reference: Huang X, Lee K, Wang MC, Sha NS, Khan SS. Age at diagnosis of hypertension by race and ethnicity in the US from 2011 to 2020. JAMA Cardiol. Published online August 3, 2022. doi: 10.1001/jamacardio.2022.2345