Many young adults (18-39 year-olds) view themselves as physically healthy and may wonder why their doctor is concerned about their blood pressure. However, being young does not prevent you from developing elevated or high blood pressure. Uncontrolled blood pressure in young adults is a significant public health concern. In the U.S., 1 in 5 young men and 1 in 6 young women have hypertension. Hypertension control also varies by age group, with only 39% of U.S. young adults with hypertension having achieved control (blood pressure < 140/90 mmHg) compared with 58% of middle-aged adults (40-59 year-olds) and 54% of older adults (≥60 year-olds). Importantly, given that young adults with hypertension have more prolonged exposure to high blood pressure, they ultimately have a higher lifetime risk for cardiovascular disease. Early monitoring, diagnosis, and managed treatment are important to reduce the risk of serious medical conditions associated with uncontrolled hypertension.
Here’s a quick primer on blood pressure values and meanings and the effect of elevated blood pressure on cardiac structure and functioning:
Blood pressure is the force that blood applies to the walls of arteries as it’s pumped throughout the body.
Generally, your arteries can withstand some pressure, but there are limits to what the arteries can handle. For this reason, blood pressure is measured and monitored, and the values are categorized based on how the level of pressure affects our health. The four blood pressure categories are:
- Normal: systolic less than 120, and diastolic less than 80
- Elevated: 120 – 129, and less than 80
- Hypertension (stage 1): 130 – 139, or 80 – 89
- Hypertension (stage 2): 140 or higher, or 90 or higher
- Hypertensive crisis: higher than 180, and/or higher than 120
Only normal blood pressure is considered healthy, while elevated or high blood pressure is associated with damaging the heart and arteries by forcing the heart to pump harder. When the heart works harder to pump blood, this can cause the heart muscles to thicken (altering the structure of the heart) and make it harder for the heart to fill with and pump blood (altering the functioning of the heart). The body’s arteries will also begin to narrow and harden, limiting the normal flow of blood.
Fortunately, high blood pressure is treatable and preventable. But uncontrolled hypertension affects nearly half of adults in the U.S., with many people unaware they even have the condition. The CDC recommends that knowing key facts about hypertension, getting your blood pressure checked regularly, and taking action to control your blood pressure if it is high is key to lowering your risk.
Since hypertension does not cause noticeable symptoms, it mustn’t be ignored. Over time, high blood pressure quietly damages the circulatory system and increases one’s risk of developing adverse health conditions – thus, hypertension is known as a silent killer. Additionally, high blood pressure is associated with poorer outcomes with COVID.
Steps to lower your blood pressure are often considered manageable and include common lifestyle modifications:
- Smoking cessation
- Maintaining a healthy weight
- Consuming low levels of salt
- Getting plenty of exercise
- Limiting alcohol
- Eating healthy
However, the patient experience among young adults with hypertension suggests significant barriers to receiving adequate blood pressure control management exist for this population. In a multi-center qualitative study, Johnson et al. (2016) identified unique emergent themes among young adults with hypertension that differed from prior hypertension qualitative studies in older age groups. Young adults voiced that the chronic disease diagnosis and the recommended lifestyle modifications made them feel older than their biological age. The participants also mentioned ongoing adverse psychological effects associated with their diagnosis and feeling a sense of self-blame and shame. This may be a critical point of intervention for healthcare teams to understand and address the negative emotional and mental health effects that a hypertension diagnosis has on young adults. Other emergent themes identified in the focus groups included the cost-benefit analysis performed by young adults when determining the necessity of recommended blood pressure treatment plan (e.g., lifestyle modifications, medication) and concern about experiencing negative social stigma based on their behavior choices reflecting new lifestyle modifications. Finally, most participants reported discarding hypertension education materials after leaving the clinic, citing that the materials were not tailored to young adults and their lifestyles.
These themes identified important barriers to young adult patients’ education on hypertension awareness and risks and opportunities for hypertension treatment non-adherence related to both medication and lifestyle modifications. Young adults with hypertension represent a unique population that could benefit from targeted interventions to improve hypertension control and cardiovascular disease prevention.
- Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
- Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-596.
- Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: Hiding in plain sight. JAMA2014;312(19):1973–1974.
- Parcha V, Patel N, Kalra R, Arora G, Arora P. Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults: Race-Stratified Analysis of the National Health and Nutrition Examination Survey. Mayo Clin Proc. 2020 Jul;95(7):1390-1403. doi: 10.1016/j.mayocp.2020.01.041. PMID: 32622447.
- Johnson HM, Warner RC, LaMantia JN, Bowers BJ. “I have to live like I’m old.” Young adults’ perspectives on managing hypertension: a multi-center qualitative study. BMC Family Practice. 2016 Dec;17(1):1-9.
- “6 Facts About High Blood Pressure.” Venngage. https://venngage.net/pl/bVswgLzcpM
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Ayana April-Sanders is an epidemiologist and postdoctoral research fellow at Albert Einstein College of Medicine. Her research focuses on the impact of social determinants of health, health disparities, and early life stress on cardiometabolic and cardiovascular disease outcomes across the life course in minority and immigrant populations. She is a member of AHA Council on Lifestyle and Cardiometabolic Health and Council on Epidemiology and Prevention. She volunteers for the AHA FIT/Early Career Blogging program. You can follow her on twitter: @AApril_Sanders.