Hypertension in Older Adolescents and Young Adults

  • Arthur Eric AndersonEmail author
Reference work entry


Few data are available on either the epidemiology or management of hypertension in older adolescents and young adults, leading to consensus recommendations for the management of hypertension in young adults aged 18 and all adults 60 years and below. The lack of guidance on cardiovascular risk modification is further compounded by limited health insurance coverage and acquisition of poor lifestyle choices, all of which contribute to the development of atherosclerotic disease and other target organ insults. This chapter will review the limited data on hypertension and its management in individuals aged 18–25, as well as the incontrovertible evidence that hypertension and atherosclerosis are progressive conditions that have their origins in the young. Societal interventions such as education regarding appropriate lifestyle choices and expansion of health insurance coverage may be the most appropriate strategies to prevent development of cardiovascular disease later in life.


Blood pressure Hypertension Young adulthood Atherosclerosis 


  1. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group (2003) Diuretic versus alpha-blocker as first-step antihypertensive therapy: final results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Hypertension 42(3):239–246CrossRefGoogle Scholar
  2. Appel LJ, Moore TN, Obarzanek E et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336:1117–1124CrossRefGoogle Scholar
  3. Beckett NS, Peters R, Fletcher AE, HYVET Study Group et al (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358(18):1887–1898CrossRefGoogle Scholar
  4. Benavente OR, Coffey CS, Conwit R, SPS3 Study Group et al (2013) Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 382(9891):507–515CrossRefGoogle Scholar
  5. Berenson GS, Srinivasan SR et al (1998) Association between multiple cardiovascular risk factors and atherosclerosis in Children and young adults: the Bogalusa heart study. NEJM 338:1650–1656CrossRefGoogle Scholar
  6. Berger JS, Jordan CO et al (2010) Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol 55:1169–1177CrossRefGoogle Scholar
  7. Berry JD, Lloyd-Jones DM et al (2007) Framingham risk score and prediction of coronary heart disease death in young adults. Am Heart J 154:80–86CrossRefGoogle Scholar
  8. Brenner BM, Cooper ME, de Zeeuw D et al (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345(12):861–869CrossRefGoogle Scholar
  9. Carnethon MR, Gidding SS et al (2003) Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA 290:3092–3100CrossRefGoogle Scholar
  10. Cavanaugh-Hussey MW, Berry JD, Lloyd-Jones DM (2008) Who exceeds ATP-III risk thresholds? Systematic examination of the effect of varying age and risk factor levels in the ATP-III risk assessment tool. Prev Med 47:619–623CrossRefGoogle Scholar
  11. Centers for Disease Control and Prevention (2013) Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease–United States, 2001–2010. Morb Mortal Wkly Rep 62:721–727Google Scholar
  12. Chobanian AV, Bakris GL, Black HR et al (2003) The seventh report of the joint National Committee on Preention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289(19):2560–2573CrossRefGoogle Scholar
  13. Cushman WC, Evans GW, Byington RP et al (2010) Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362(17):1575–1585CrossRefGoogle Scholar
  14. Dahlof B, Devereux RB, Kjeldsen SE et al (2002) Cardiovascular morbidity and mortality in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359(9311):995–1003CrossRefGoogle Scholar
  15. Enos WF, Homes RH et al (1953) Coronary disease among United States soldiers killed in action in Korea. JAMA 152:1090–1093CrossRefGoogle Scholar
  16. Ford ES, Capewell S (2011) Proportion of the decline in cardiovascular disease mortality due to prevention versus treatment: public health versus clinical care. Annu Rev Public Health 32:5–22CrossRefGoogle Scholar
  17. Ford ES, Giles WH et al (2004) The distribution of 10-year risk for coronary heart disease among U.S. adults: findings from the National Health and Nutrition examination Survey III. J Am Coll Cardiol 43:1791–1796CrossRefGoogle Scholar
  18. Furman J, Fielder M (2015) 4.5 million young adults have gained coverage since 2010. In: Improving access to care and benefitting our economy. Obama white house archives. Available at Last accessed 15 April 2017
  19. Goff DC, Lloyd-Jones DM et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 129(2):S49–S73CrossRefGoogle Scholar
  20. Gu Q, Burt VL, Dillon CF, Yoon S (2012) Trends in antihypertensive medication use and blood pressure control among united states adults with hypertension – National Health and Nutrition examination Survey, 2001–2010. Circulation 126:2105–2114CrossRefGoogle Scholar
  21. Hansson L, Zanchetti A, Carruthers SG et al (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial. Lancet 351(9118):1755–1762CrossRefGoogle Scholar
  22. Hypertension Detection and Follow-up Program Cooperative Group (1979) Five-year findings of the hypertension detection and follow-up program, I: reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 242(23):2562–2571CrossRefGoogle Scholar
  23. Intersalt Cooperative Research Group (1998) Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ 297:319–328Google Scholar
  24. IPPPSH Collaborative Group (1985) Cardiovascular risk and risk factors in a randomized trial of treatment based on the beta-blocker oxprenolol: the international prospective primary prevention study in hypertension (IPPPSH). J Hypertens 3(4):379–392CrossRefGoogle Scholar
  25. James PA, Oparil S et al (2014) 2014 evidence-based guideline for the Management of High Blood Pressure in adults: report from the panel members appointed to the eighth join National Committee. JAMA 311(5):507–5020CrossRefGoogle Scholar
  26. JATOS Study Group (2008) Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 31(12):2115–2127CrossRefGoogle Scholar
  27. Klahr S, Levey AS, Beck GJ et al (1994) The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 330(13):877–884CrossRefGoogle Scholar
  28. Lewington S (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis. Lancet 360(9349):1903CrossRefGoogle Scholar
  29. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 329(20):1456–1462CrossRefGoogle Scholar
  30. Lewis EJ, Hunsicker LG, Clarke WR et al (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345(12):851–860CrossRefGoogle Scholar
  31. Lloyd-Jones DM, Leip EP, Larson MG et al (2006) Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation 113:791–798CrossRefGoogle Scholar
  32. McGill HC, McMahan A, Gidding SS (2008) Preventing heart disease in the 21st century: implications of the Pathobiological determinants of atherosclerosis in youth (PDAY) study. Circulation 117:1216–1227CrossRefGoogle Scholar
  33. McNamara JJ, Molot MA et al (1971) Coronary artery disease in combat casualties in Vietnam. JAMA 216:1185–1187CrossRefGoogle Scholar
  34. Medical Research Council Working Party (1985) MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed) 291(6488):97–104CrossRefGoogle Scholar
  35. Murphy SL, Xu J, Kochanck KD (2013) Deaths: final data for 2010. Natl Vital Stat Rep 61(4):1–117PubMedGoogle Scholar
  36. National Center for Health Statistics (2016) Health, United States, 2015: with special feature on racial and ethnic health disparities. Hyattsville, Maryland. Available at Last accessed 15 April 2017
  37. Ogihara T, Saruta T, Rakugi H et al (2010) Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension 56(2):196–202CrossRefGoogle Scholar
  38. Ostchega Y, Yoon SS, Hughes J, Louis T (2008) Hypertension awareness, treatment, and control – continued disparities in adults: United States. NCHS Data Brief 2005–2006:1–8Google Scholar
  39. Patel A, MacMahon S, Chalmers J et al (2007) Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 370(9590):829–840CrossRefGoogle Scholar
  40. Ruggenenti P, Perna A, Gherard G, REIN Study Group et al (1999) Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 354:359–364CrossRefGoogle Scholar
  41. Selassie A, Wagner CS, Laken ML et al (2011) Progression is accelerated from prehypertension to hypertension in blacks. Hypertension 58:579–587CrossRefGoogle Scholar
  42. SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program (SHEP). JAMA 265(24):3255–3264CrossRefGoogle Scholar
  43. Siu AL, U.S. Preventive Services Task Force (2015) Screening for high blood pressure in adults: U.S. preventive services task force recommendation statement. Ann Intern Med 163(10):778–787CrossRefGoogle Scholar
  44. Staessen JA, Fagard R, Thijs L et al (1997) The systolic hypertension in Europe (Syst-Eur) trial investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 350(9080):757–764CrossRefGoogle Scholar
  45. Steinberger J, Daniels SR, Hagberg N et al (2016) Cardiovascular health promotion in Children: challenges and opportunities for 2020 and beyond. A scientific statement from the American Heart Association. Circulation 134(12):e236–e255CrossRefGoogle Scholar
  46. Strong JP, McGill HC (1962) The natural history of coronary atherosclerosis. Am J Pathol 40:37–49PubMedPubMedCentralGoogle Scholar
  47. The SPRINT Research Group (2015) A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373:2103–2116CrossRefGoogle Scholar
  48. Towfighi A, Markovic D, Ovbiagele B (2011) Recent patterns of sex-specific midlife stroke hospitalization rates in the United States. Stroke 42:3029–3033CrossRefGoogle Scholar
  49. Uberoi N, Finegold K, Gee E (2016) Health insurance coverage and affordable care act, 2010-2106. Department of Health & Human Services, ASPE Issue Brief 1–14. Available at Last accessed 15 April 2017
  50. UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317(7160):703. BMJ 1999 Jan 2;318(7175):29CrossRefGoogle Scholar
  51. US Census Bureau (2012) Health insurance historical tables – HIB series. Washington, DC, US Department of Commerce, US Census Bureau. Available at Last accessed 15 April 2017
  52. VA Cooperative Study Group on Antihypertensive Agents (1967) Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mmhg. JAMA 202(11):1028–1034CrossRefGoogle Scholar
  53. Vasan RS, Beiser A, Seshadri S et al (2002) Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham heart study. JAMA 287:1003–1010CrossRefGoogle Scholar
  54. Ventura HO, Lavie CJ (2011) Antihypertensive therapy for prehypertension: relationship with cardiovascular outcomes. JAMA 305(9):940–941CrossRefGoogle Scholar
  55. Verdecchia P, Staessen JA, Angeli F et al (2009) Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (cardio-sis): an open-label randomised trial. Lancet 374(9689):525–533CrossRefGoogle Scholar
  56. Winegarden CR (2005) From “prehypertension” to hypertension? Additional evidence. Ann Epidemiol 15:720–725CrossRefGoogle Scholar
  57. Wright JT Jr, Bakris G, Greene T et al (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288(19):2421–2431CrossRefGoogle Scholar
  58. Yusuf S, Teo KK, Pogue J et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358(15):1547–1559CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Nephrology, Department of MedicineUniversity of Washington Medical CenterSeattleUSA

Section editors and affiliations

  • Joseph T. Flynn
    • 1
    • 2
  1. 1.Department of PediatricsUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of NephrologySeattle Children’s HospitalSeattleUSA

Personalised recommendations