Undetected Hypertension Common among Young Adults

Many young adults age 18-24 with high blood pressure remain undiagnosed with hypertension, even after long-term physician care.

Young adults in the US with high blood pressure are less likely to be diagnosed during a doctor visit than patients age 60 and older.

Study results presented at the American Heart Association 2012 Scientific Sessions, in Los Angeles, California, show that young adults ages 18-24 with high blood pressure are 28% less likely to be diagnosed during regular doctor visits.

However, the factors contributing to the delays in diagnosing hypertension (HTN) in young adults are not known. The purpose of this study was to determine predictors of delays in the initial HTN diagnosis among young adults.

“These young patients come to the clinic and their blood pressure is recorded,” said lead author Heather Johnson, MD, of the University of Wisconsin School of Medicine and Public Health. “They have high blood pressure, but there’s no documentation of a diagnosis.”

Researchers performed an analysis of the electronic health records of 13,593 men and women who were at least 18 years old. Patients with a previous HTN diagnosis or previous antihypertensive medication were excluded. All of the patients had visited their practicing physician at least twice as an outpatient. They had previously had high blood pressure, met the criteria for an initial HTN diagnosis, and met the required guidelines for the study.

However, after four years physician care:

  • 67% of adults age 18-24 years meeting clinical criteria for HTN remained undiagnosed
  • 65% of adults age 25-31 years meeting clinical criteria for HTN remained undiagnosed
  • 59% of adults age 32-39 years meeting clinical criteria for HTN remained undiagnosed
  • Young adults with depression, hypothyroidism, lung disease, higher healthcare utilization scores, higher urgent care use, and a non- English primary language were less likely to be diagnosed
  • Patients with minority status, higher weight, diabetes, dyslipidemia, chronic kidney disease, more primary care visits, and a female provider were more likely to receive a diagnosis of HTN
  • Pediatricians and specialty providers were more likely to diagnose HTN in young adults as compared to Internal Medicine, Family Practice, and OB/Gyn practitioners

Young adult patients with mild hypertension and those who were smokers were also less likely to receive a diagnosis.

According to American Heart Association statistics, about 29% of all adults living in the United States have hypertension. Men (11%) age 20-34 have a slightly higher rate of hypertension than women (7%) the same age.

“Patient factors play a role, provider factors play a role, along with the health care system,” Johnson said. “You can’t blame one component. They all must work together to diagnose and manage high blood pressure in young adults.”