Adherence matters—even in young adults with hypertension

This commentary refers to ‘Antihypertensive treatment in young adults and cardiovascular risk: a population-based cohort study’, by F. Rea et al., https://doi.org/10.1093/eurheartj/ehaf744. Adherence matters—even in young adults with hypertension. The recent study by Rea et al.1 provides important evidence that adherence to antihypertensive therapy significantly reduces cardiovascular hospitalizations in young adults, a group traditionally considered at low absolute risk and largely absent from randomized trials. This observation challenges the long-standing perception that the benefits of antihypertensive treatment accrue predominantly in later life and, importantly, reinforces current guideline recommendations for early intervention.2,3 Several aspects merit closer consideration. Although the relative risk reduction was broadly similar in young and middle-aged patients, the absolute event rates in young adults were markedly lower, translating into smaller absolute benefits.4 Here lies a central clinical dilemma: how to balance the promise of lifetime cardiovascular protection against the immediate costs, risks, and treatment burden in asymptomatic young individuals. It would be valuable for future research to move beyond reporting relative risks and instead quantify lifetime benefit using approaches such as microsimulation or target trial emulation, which may help bridge this gap.5