Age at Hypertension Diagnosis Younger in Black, Hispanic Adults in US

Sadiya S. Khan, MD, MSc

Earlier hypertension onset in the Black and Hispanic adults may contribute to racial and ethnic cardiovascular disease (CVD) disparities, according to new findings from a cross-sectional study.

The mean age of hypertension diagnosis was observed to be 4 to 5 years earlier among Black and Hispanic adults versus White adults in the US between 2011 and 2020.

“Lower hypertension awareness among racial and ethnic minoritized groups suggests potential for underestimating differences in age at onset,” wrote study author Sadiya S. Khan, MD, MSc, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine.

With an earlier age at the onset of hypertension, there is greater potential for cumulative exposure to high blood pressure (BP) across the life course to be associated with increased risk of CVD. Meanwhile, it may also contribute to racial disparities in hypertension-related outcomes.

The investigators worked to identify any racial and ethnic differences in age at hypertension onset using a contemporary, nationally representative sample. Data was collected from the National Health and Nutrition Examination Surveys (NHANES) 2011 to 2020 and analyzed 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 then calculated overall and for each self-reported race and ethnicity group.

Data were pooled across cycles due to no significant trends observed, the investigators said. The team calculated the proportion of adults diagnosed at age 50 years or younger, 40 years or younger, and 30 years or younger.

Additionally, the team used multivariate regression models adjusted for sex, educational level, and household income to assess the association between race and ethnicty and age at hypertension diagnosis. They estimated the age-adjusted proportion of participants unaware of hypertension with objectively measured high BP of 140/90 mm Hg or greater and separately 130/80 mm Hg or greater.

The population consisted of 9627 participants who recorded a diagnosis of hypertension. Their races and ethnicities included Asian, Hispanic, Black, and White.

Data show the mean age at hypertension diagnosis was 46 years, with significantly younger age at diagnosis among Black (age 42 years) and Hispanic (age 43 years) adults compared to White adults (age 47 years; P <.01).

However, investigators noted there was no difference in age at hypertension diagnosis observed between Asian and White adults. 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, for those who did not report a hypertension diagnosis, a higher proportion of Asian (24%; P <.01), Black (28%; P <.01), and Hispanic (21%; P = .01) adults were unaware of hypertension (BP ≥140/90 mm Hg) compared to White adults (16%). Similar patterns for adults with BP of ≥130/80 mmHg were observed.

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

The research letter, “Age at Diagnosis of Hypertension by Race and Ethnicity in the US From 2011 to 2020,” was published in JAMA Cardiology.