Hypertension in Young Adults: Social Determinants of Prevalence, Awareness, Treatment, and Control

Hypertension prevalence remains high among US young adults, and the role of social needs in their hypertension management remains poorly understood.

Data from 2017 to 2020 National Health and Nutrition Examination Surveys (N = 8,024, representing 244 million adults) were used to study hypertension, defined per 2017 ACC/AHA guidelines or self-report of blood pressure-lowering medications. Prevalences of hypertension, awareness of condition, treatment if aware, and control if treated were estimated among young (18-39 years), middle-aged (40-64 years), and older adults (≥65 years). Weighted log binomial regression estimated associations between social needs (0, 1, or ≥2) and hypertension outcomes, adjusted for age, sex, and race/ethnicity. Social needs included less than high school education, family income <100% of the federal poverty level, no health insurance, food insecurity based on the U.S. Food Security Survey, and current unemployment.

Among 2,680 young adults (weighted N = 92 million; 51% female, 58% NHW), hypertension prevalence was 22.6% (95% CI, 19.5-25.7). Among those with hypertension, 19.3% of young, 20.2% of middle-aged, and 10.0% of older adults had ≥2 social needs. Among treated adults, those with ≥2 vs no social needs were less likely to have controlled hypertension (adjusted risk ratio [aRR]: 0.74; 95% CI, 0.59-0.92). This aRR was 0.75 (95% CI, 0.43-1.32) in young adults, 0.74 (95% CI, 0.57-0.96) in middle-aged adults, and 0.73 (95% CI, 0.51-1.04) in older adults (p for interaction = 0.12).

Unmet social needs, more prevalent among young adults, were associated with lower rates of hypertension control, highlighting directions for interventions.