Hypertension in Young Adults: What It Is and Why it Happens

Reviewed by Dr. Jonathan Bonnet, MD, MPH


Most young adults don’t consider themselves at risk for hypertension—especially if they’re regularly active and otherwise healthy. However, data shows that the prevalence of hypertension in young adults is growing. Specifically, data from the CDC shows that the rate of hypertension in people aged 18-39 is 22.4%.


To make matters more complicated, experts have found that awareness, treatment, and control of the disease are particularly low among US adults between the ages of 20 and 39.


This is why understanding the risk factors for hypertension and how to screen for and manage the disease is key to maintaining optimal health and quality of life.


What is hypertension?


Hypertension, also called high blood pressure, refers to the amount of resistance to blood flow in your arteries. This resistance is measured in millimeters of mercury at two time points–when your heart beats and when it is resting between beats.


If your blood pressure is high, your heart is pumping more blood through narrower arteries. Though blood pressure can rise in moments of acute stress, consistently high blood pressure or hypertension can increase your risk of certain cardiovascular diseases including heart attack and stroke.


Blood pressure readings reflect these two measurements:



  • Systolic pressure: The first or top number measures the pressure in your arteries when your heart is beating.

  • Diastolic pressure: The second lower number measures the pressure in your arteries between heartbeats.


For many years, the hypertension cutoff was 140/90 mm HG. However, in 2017, the American College of Cardiology (ACC) lowered the in-clinic threshold for hypertension. This was done because large data sets suggested that there was an increased risk of coronary heart disease and stroke with hazard ratios of 1.1-1.5 in people with blood pressure at or above 120/80.


According to the new threshold, stage 1 hypertension for young adults is now defined as having ranges at or above 130/80 mm HG. (Ranges between 120/80 and 130/80 are considered elevated.)































Category



Systolic pressure



Diastolic pressure



Normal



<120 mm Hg



<80 mm Hg



Elevated



120-129 mm Hg



< 80 mm Hg



Stage 1 Hypertension



130-139 mm Hg



80-89 mm Hg



Stage 2 Hypertension



≥ 140 mm Hg



≥ 90 mm Hg



Under this new threshold, the prevalence of hypertension among young adults increased by nearly three-fold. Today, an estimated 40-50% of US adults 18 and over have hypertension. Though lowering the diagnostic criteria contributed significantly to the increase of young adults living with hypertension, there are additional possible causative factors, including an increase in insulin resistance and subsequent worsening of metabolic health.


What are the risk factors for hypertension?


There are several factors that can put young adults at risk of hypertension. According to the Framingham Offspring Study, the following factors were associated with increased risk for developing hypertension in people aged 20-49:



  • Increased adiposity: Also known as increased fatty tissue or obesity.

  • High uric acid level: When your kidneys don’t eliminate uric acid efficiently (a waste product found in the blood). In addition to being a risk factor for hypertension, high uric acid levels can also be a result of having type two diabetes, inherited tendencies, drinking excessive amounts of alcohol, or taking certain medications or supplements (including immune-suppressing drugs and diuretics).

  • High resting heart rate: An elevated resting heart rate can also be a risk factor for hypertension. A normal resting heart rate for adults is generally between 60 to 90 beats per minute. However, lower heart rates can be “normal” in well-trained individuals (even as low as 30 beats per minute!). There are several at-home and wearable devices that can measure your resting heart rate, as well as your heart rate variability. However, if you’re unsure how to interpret the result, contact your provider for more information.

  • Hypertriglyceridemia: Hypertriglyceridemia is defined as an abnormal concentration of triglycerides in the blood (greater than 150 mg/DL). It’s a commonly found abnormality that’s often associated with other lipid and metabolic conditions. A fasting lipid panel can screen for hypertriglyceridemia.

  • Alcohol consumption (women): For young women aged 25-45, alcohol consumption may be an additional risk factor for hypertension. Specifically, women who drink heavily may have a demonstrated increase in hyypertension risk.

  • High levels of fasting insulin: In young adults between the ages of 18-30, high levels of fasting insulin have also been associated with adverse cardiovascular risk factors, including hypertension.

  • Race: Young Black Americans are more likely to have hypertension when compared with young White or Hispanic Americans. Black women are also more likely to have hypertension when compared with Black men of the same age range.


How do I know if my blood pressure is elevated?


Thankfully, screening for high blood pressure is simple. Though you may have high blood pressure for years without experiencing any noticeable symptoms, it can be easily detected through an at-home or in-clinic blood pressure reading.


In fact, most providers will include a blood pressure reading as part of their annual wellness exam.


A blood pressure machine or cuff—like those found in clinics, pharmacies, or purchased online—can measure your blood pressure levels. (If measuring your blood pressure at home, be sure to use a device with an appropriately sized cuff.) An advantage of measuring your blood pressure at home is that it can give you a better sense of what your blood pressure is day-to-day. Sometimes, blood pressures are elevated at the doctor’s office (termed "white coat hypertension") due to “visiting the doctor nerves”, even when levels are normal at most other times. Because blood pressure is a chronic problem, these infrequent slight elevations are not considered harmful.


Depending on your health and risk factors, your provider may recommend monitoring blood pressure levels at home, either through the use of ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM).


What can I do to lower my blood pressure?


There are several lifestyle management techniques that can help to manage hypertension. Though each of these behaviors can offer independent benefits, incorporating more than behavior can provide additive benefits.



  • Dietary patterns: Nutrition can have a significant impact on cardiovascular and hypertension risk. However, focusing on specific dietary patterns may be more impactful than the consumption or elimination of individual foods. Generally, a diet consisting of minimally processed whole foods is recommended. One well-studied eating pattern to reduce hypertension and cardiovascular risk is referred to as the Mediterranean-style diet (MED). This diet tends to be moderate in total fat, low in saturated fat, and high in both polyunsaturated fat (like those from oils and fatty fish) and fiber. Another similar type of dietary pattern called DASH is also recommended for hypertension management.

  • Reducing sodium: For people who are salt sensitive, reducing your salt intake can help to significantly lower your blood pressure. On average, most people who reduce sodium intake can decrease their systolic blood pressure by 2-7 points and diastolic blood pressure by 1-3 points.

  • Increasing physical activity: There’s a large body of evidence to suggest that higher levels of physical activity can lower the risk of cardiovascular disease and enhance longevity. But when it comes to lowering blood pressure and improving lipid levels associated with hypertension, aerobic exercise may be more beneficial than other types of activity, like resistance training.


If lifestyle changes aren’t enough to get your blood pressure into an ideal range in rare cases, your provider may recommend medications.


The bottom line


Hypertension can put you at an increased risk for many serious conditions, including heart disease, heart failure, stroke, and even early death. But because people with high blood pressure don’t often experience symptoms, it can go undetected for many years.


This is why early detection is key. Connecting with a provider to assess your risk and personal health goals is the first step in optimizing your health in the long run.


Sources


2013 AHA/ACC Guideline on LIfestyle Management to Reduce Cardiovascular Risk. (2013).


2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017).


Blood Pressure in Young Adults and Cardiovascular Disease Later in Life. (2021).


High blood pressure (hypertension). (2021).


Hypertension in young adults. (2016).


Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017-2018. (2020).


Hypertriglyceridemia. (2006).


Real-world heart rate norms in the Health eHeart study. (2019).


Resting heart rate: what is normal? (2017).

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