Hypertension in the Young Adult Trauma Population: Rethinking the Traditional "Incidentaloma"

Hypertension (HTN) is a treatable and preventable risk factor for cardiovascular disease that is often overlooked in young adults. As a result, young patients with HTN may enter the health care system as a trauma without a preexisting diagnosis. The potential impact of HTN (diagnosed and undiagnosed) on trauma outcomes is not known.

Patients aged 18-39 y from the 2013-2017 North Carolina Trauma Registry were included. Patients were stratified as having no HTN, previously diagnosed HTN (PD-HTN), or newly diagnosed HTN (ND-HTN) during a trauma admission. Multivariable logistic and linear regression compared inpatient outcomes between patients with and without HTN, as well as ND-HTN and PD-HTN.

Six percent of trauma patients were diagnosed with HTN (n = 1906; 14% ND-HTN). Those with HTN were more likely to have an inpatient complication (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.32-2.07) and intensive care unit stay (OR: 1.28, 95% CI: 1.12-1.46) compared with patients without HTN. Compared with PD-HTN, those with ND-HTN were more likely to present with extreme injury. In addition, patients with ND-HTN had higher odds of inpatient complications (OR: 1.95, 95% CI: 1.18-3.22) and 30-d readmission (OR: 2.00, 95% CI: 0.95-4.20) after accounting for demographics and injury severity.

More than 10% of young adult trauma patients with HTN are not diagnosed before admission. HTN appears to have a detrimental impact on patient outcomes, with newly diagnosed patients having the worst outcomes. Trauma may serve as an opportunity for the diagnosis and treatment of HTN in young adults. Future studies should assess the impact of intervention on trauma outcomes.