Early-Onset Hypertension

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Early-onset hypertension (n=39774). Intervention: Early-onset hypertension (age ≤45 years) vs. Subjects without hypertension. Primary outcome: Cardiovascular disease (myocardial infarction and stroke) (HR 2.26, 95% CI 1.19-4.30).

Q: What does this research mean for the field?

Early-onset hypertension is associated with an increased risk of cardiovascular disease and transmission to offspring compared to late-onset hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Teemu Niiranen; Karri Suvila; Susan Cheng

doi:10.1016/j.jacc.2020.04.059

June 1, 2020Journal of the American College of CardiologyOpen Access

Early-Onset Hypertension

View Full Paper

Ask AI

Bookmark

Share

Key result

Early-onset hypertension (age ≤45 years) significantly increased the risk of cardiovascular disease (HR 2.26) and all-cause mortality compared to individuals without hypertension.

Why the study?

Does early-onset hypertension increase the risk of cardiovascular disease and all-cause mortality compared to individuals without hypertension?

Key Points

To investigate the association between the age of hypertension onset and subsequent risks of cardiovascular disease and all-cause mortality.
Prospective cohort analysis evaluated 19,887 participants with incident hypertension matched to 19,887 age- and sex-matched controls without hypertension from the Kailuan cohort (N=101,510) in China, followed biennially from 2006 to 2017 over a mean follow-up of 6.5 years.
Cox proportional hazards regression models were used to assess the primary cardiovascular disease outcomes (myocardial infarction and stroke) and all-cause mortality across subgroups defined by age at hypertension onset.
Participants with hypertension-onset age ≤45 years experienced the greatest risk of cardiovascular disease (HR: 2.26; 95% CI: 1.19 to 4.30) and all-cause mortality (HR: 2.59; 95% CI: 1.32 to 5.07).
Risk estimates steadily declined with each later decade of onset, with the lowest hazards observed among participants with hypertension-onset age ≥65 years for cardiovascular disease (HR: 1.33; 95% CI: 1.04 to 1.69) and all-cause mortality (HR: 1.29; 95% CI: 1.11 to 1.51).

Structured PICO

Does early-onset hypertension increase the risk of cardiovascular disease and all-cause mortality compared to individuals without hypertension?

P

Population

39,774 Chinese community-dwelling adults, comprising 19,887 with new-onset hypertension and 19,887 matched controls, followed for a mean of 6.5 years to assess cardiovascular risk.

E

Exposure

Early-onset hypertension (age ≤45 years)

C

Comparator

Subjects without hypertension

O

Outcome

Cardiovascular disease (myocardial infarction, stroke)hard clinical

Main Result

Hazard Ratio: 2.26 (95% CI 1.19–4.3)

Limitations

Mean follow-up duration was relatively short at 6.5 years
Initial cohort consisted of employees of a single company with 65.3% participation rate, contributing to potential selection bias
Models were adjusted for fasting blood glucose but not for the use of antihyperglycemic medication
Blood pressure levels during and prior to the outcome assessments were not considered

Implication

Early-onset hypertension confers a significantly higher risk of cardiovascular disease and mortality than late-onset hypertension, suggesting a need for more intensive early management.

Abstract

High blood pressure remains a leading modifiable risk factor for cardiovascular disease (CVD) in both the young and the old (1,2). Surprisingly few studies have examined the age at which hypertension begins and its relation to later-life risk for CVD outcomes (3–8). The evidence to date would suggest that an early age of hypertension onset is associated with not only increased risk of CVD, but also transmission to offspring, whereas hypertension onset in later life is more benign in nature (3–8). Importantly, prior analyses have involved predominantly retrospective case-control designs that may be subject to selection or recall bias and are also limited in their ability to establish a temporal relationship between the exposure and outcome. In this issue of the Journal, Wang et al. (9) effectively advance our understanding by investigating the prognosis of early compared with late hypertension onset in relation to CVD risk in the setting of a large cohort study design.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Niiranen et al. (2020) conducted an editorial in Early-onset hypertension (n=39,774). Early-onset hypertension (age ≤45 years) vs. Subjects without hypertension was evaluated on Cardiovascular disease (myocardial infarction and stroke) (HR 2.26, 95% CI 1.19-4.30). Early-onset hypertension (age ≤45 years) significantly increased the risk of cardiovascular disease (HR 2.26) and all-cause mortality compared to individuals without hypertension.

synapsesocial.com/papers/6aa07bb67946366d2057eb19 https://doi.org/10.1016/j.jacc.2020.04.059

Topics

Hypertension management

View Full Paper

Ask AI

Bookmark

Share

Early-Onset Hypertension

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Early-Onset Hypertension

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Topics

Keep reading