Hypertension Manifests Earlier in Black, Hispanic Adults vs White Adults

A 4- to 5-year age difference separates hypertension diagnosis in non-Hispanic Black and non-Hispanic White adults, with the former seeing this diagnosis earlier, according to 2011-2020 data from the National Health and Nutrition Examination Surveys.

Patients self-reported their hypertension diagnosis following its delivery from a clinician, and the age disparity demonstrates potential lower awareness of the condition among racial and ethnic minoritized groups, according to the authors of a new investigation published in JAMA Cardiology. Age at diagnosis was stratified by 50 years or younger, 40 years or younger, and 30 years or younger, with data analyzed from January to April 2022 and mean age calculated overall and for each race and ethnicity group, for 9517 participants (n = 3631 White patients, 2850 Black patients, 1880 Hispanic patients, 811 Asian patients).

“Hypertension prevalence is disproportionately higher among non-Hispanic Black adults vs non-Hispanic White adults and may develop at younger ages,” they wrote. “Earlier age at hypertension onset may mean greater cumulative exposure to high blood pressure [BP] across the life course, which is associated with increased risk of cardiovascular disease, and may contribute to racial disparities in hypertension-related outcomes.”

The mean (SD) overall age at hypertension diagnosis was 46 (15) years, with White and Asian patients being older at diagnosis (47 [15] and 48 [14] years, respectively) vs Hispanic and Black patients (43 [15] and 42 [14] years, respectively). The investigators deemed these age differences significant.

These age trends could also be seen in the overall population, with the current mean (SD) ages at time of study inclusion being 53 (15) and 55 (15) in Hispanic and Black patients, respectively, compared with 58 (14) and 59 (15) in White and Asian patients, respectively.

Using patients of White ethnicity as the reference point, the authors’ age stratification analysis showed the following results:

• Diagnosed at 50 years or younger: Black patients (73%; P = .96) and Hispanic patients (70%; P < .01) were most likely to receive a hypertension diagnosis before age 50 years compared with Asian patients (59%; P = .96) and White patients (61%; reference)
• Diagnosed at 40 years or younger: Black patients had the highest prevalence of a hypertension diagnosis (48%; P < .01) and Asian patients the lowest prevalence (29%; P = .23); Hispanic and White patients fell in the middle (44%; P < .01; and 35%; reference, respectively)
• Diagnosed at 30 years or younger: Black patients were the most likely (25%; P < .01), followed by Hispanic (23%; P < .01), White (17%; reference), and Asian (12%; P = .42) patients

When data were gathered on the proportion of adults who were unaware of hypertension, the investigators found that for BPs of 140/90 mm Hg or higher and 130/80 mm Hg or higher, Black patients were the most likely to be unaware, at 28% and 51% (P < .01 for both), respectively, compared with White patients, at 16% and 36%. Interestingly, the proportions of adults unaware of hypertension were higher overall and among each race/ethnicity group for a BP of 130/80 mm Hg or higher vs 140/90 mm Hg or higher, respectively:

• Overall: 38% and 18%
• Hispanic patients: 42% and 21%
• Asian patients: 44% and 24%
• Black patients: 51% and 28%
• White patients: 36% and 16%

Speaking to the clinical implications of their findings, the authors noted the potential for disparities in cardiovascular disease (CVD) care, and that factors contributing to earlier hypertension onset could include upstream structural and systemic factors.

“Greater cumulative exposure of high BP is associated with subclinical and clinical CVD,” they concluded. “These findings emphasize the importance of hypertension prevention and screening in young adulthood and adolescence.”

Reference

Huang X, Lee K, Wang MC, Shah NS, Khan SS. Age at diagnosis of hypertension by race and ethnicity in the US from 2011 to 2020. JAMA Cardiol. 2022;7(9):986-987. doi:10.1001/jamacardio.2022.2345