Original Investigation
Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality

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Abstract

Background

The relations of hypertension onset age with cardiovascular diseases (CVD) and all-cause mortality remain inconclusive.

Objectives

This study sought to examine the associations of hypertension onset age with CVD and all-cause mortality.

Methods

This prospective study included 71,245 participants free of hypertension and CVD in the first survey (July 2006 to October 2007) of the Kailuan study, a prospective cohort study in Tangshan, China. All participants were followed biennially until December 31, 2017. A total of 20,221 new-onset hypertension cases were identified during follow-up. We randomly selected 1 control participant for each new-onset hypertensive participant, matching for age (±1 year) and sex, and included 19,887 case-control pairs. We used weighted Cox regression models to calculate the average hazard ratios of incident CVD and all-cause mortality across the age groups.

Results

During an average follow-up of 6.5 years, we identified 1,672 incident CVD cases and 2,008 deaths. After multivariate adjustment, with the increase in hypertension onset age, the hazards of outcomes were gradually attenuated. The average hazard ratio (95% confidence interval) of CVD and all-cause mortality were 2.26 (1.19 to 4.30) and 2.59 (1.32 to 5.07) for the hypertension onset age <45 years old group, 1.62 (1.24 to 2.12) and 2.12 (1.55 to 2.90) for the 45- to 54-year age group, 1.42 (1.12 to 1.79) and 1.30 (1.03 to 1.62) for the 55- to 64-year age group, and 1.33 (1.04 to 1.69) and 1.29 (1.11 to 1.51) for the ≥65-year age group, respectively (p for interaction = 0.38 for CVD and <0.01 for death).

Conclusions

Hypertension was associated with a higher risk for CVD and all-cause mortality, and the associations were stronger with a younger age of onset.

Key Words

cardiovascular disease risk
early-onset hypertension
mortality risk

Abbreviations and Acronyms

AHR
average hazard ratio
BP
blood pressure
CI
confidence interval
CVD
cardiovascular disease
eGFR
estimated glomerular filtration rate
FBG
fasting blood glucose
HS
hemorrhagic stroke
IS
ischemic stroke
MI
myocardial infarction
TC
total cholesterol

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All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

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Drs. Wang and Yuan contributed equally to this work.