Cardiovascular and Kidney Events Associated with Visit-to-Visit Blood Pressure Variability among Young Adults with Hypertension

BACKGROUND: Blood pressure (BP) variability and long-term BP exposure is associated with cardiorenal events. We investigated the associations of visit-to-visit BP variability and cumulative BP exposure with cardiorenal events in young adults with hypertension. METHODS: We identified adults aged 18-39 years with stage 1 or 2 hypertension between 2009 and 2019 from a large US-integrated healthcare system. BP variability was assessed using coefficient of variation, and cumulative BP exposure was calculated as the time-weighted average over 3 years prior to the index date. Cox proportional hazards models assessed associations with incident cardiovascular and kidney events, adjusting for baseline BP and covariates. RESULTS: Among 151,692 young adults, 812 cardiovascular and 1194 kidney events occurred over a median of 5.4 years. Both systolic BP (SBP) variability and time-weighted average SBP exhibited J-shaped or linear associations with cardiorenal events, especially among stage 1 hypertension. In this group, SBP variability at the 90th vs 50th percentile was associated with increased risks of cardiovascular (HR = 1.25; 95% CI, 1.07-1.46) and kidney events (HR = 1.24; 95% CI, 1.09-1.41), after adjusting for baseline BP. Time-weighted average SBP of 140 vs 120 mm Hg was associated with increased risks of cardiovascular (HR = 2.58; 95% CI, 1.82-3.65) and kidney events (HR = 1.56; 95% CI, 1.16-2.10). Time-weighted average diastolic BP of 90 vs 80 mm Hg was associated with cardiovascular (HR = 3.65; 95% CI, 2.18-6.14) and kidney events (HR = 1.53; 95% CI, 0.96-2.42). CONCLUSIONS: BP variability and cumulative BP exposure may be important prognostic markers for cardiorenal events in young adults, particularly those with stage 1 hypertension.