Key result
New-onset hypertension before age 45 linked to ~336% higher risk of kidney or CV events.
Why the study?
Hypertension causes a substantial burden of disease, but the impact of a new hypertension diagnosis on kidney or cardiovascular events and mortality among community dwellers required evaluation.
Does a new diagnosis of hypertension increase the risk of kidney or cardiovascular events and mortality in community dwellers without prior cardiovascular disease?
Cohort (n=144,716)
Yes
Does a new diagnosis of hypertension increase the risk of kidney or cardiovascular events and mortality in community dwellers without prior cardiovascular disease?
Effect estimate: HR 4.36 (95% CI 3.80-5.00)
p-value: p=<0.001
A new diagnosis of hypertension in primary care is strongly associated with increased kidney and cardiovascular events across all ages, but only increases total mortality when diagnosed before age 55.
Highlights elevated K/CVE risk with early-onset hypertension in primary care; leaves open whether intensified management improves outcomes.
BACKGROUND: Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. METHODS: Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. RESULTS: The median follow-up was 138.61 months (IQR: 124.68-143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80-5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64-210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90-3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02-1.28 for ages 45 to 54). CONCLUSION: The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.
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Martín‐Fernández et al. (2023) conducted a cohort in Hypertension (n=144,716). Hypertension diagnosis vs. Matched patients without hypertension was evaluated on Kidney or cardiovascular events (diagnoses before 45 years of age) (HR 4.36, 95% CI 3.80-5.00, p=<0.001). Newly diagnosed hypertension in patients without prior cardiovascular or kidney disease was associated with a significantly increased risk of kidney or cardiovascular events, with an HR of 4.36 for those diagnosed before age 45.
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