Adverse childhood experiences and hypertension jointly increase cardiovascular risk: evidence from three national aging cohorts

OBJECTIVE: Adverse childhood experiences (ACEs) have been increasingly recognized as potential predictors of cardiovascular disease (CVD), alongside established factors such as hypertension. This study examined their independent and combined effects on CVD incidence and explored possible interactions between ACEs and hypertension. METHODS: Using data from three nationally representative prospective cohorts (CHARLS, ELSA, and HRS), we examined the associations of ACEs and hypertension with CVD incidence. Cox proportional hazards models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI), and to test both additive and multiplicative interactions between ACEs and hypertension. RESULTS: A total of 12,165 participants (42.36% male; median age, 62.00 years) were included. During follow-up, 2,975 incident CVD cases were identified across the three cohorts. Compared with participants with low ACEs exposure and no hypertension, those with high ACEs alone (pooled HR = 1.373, 95% CI: 1.158–1.627) or hypertension alone (pooled HR = 1.595, 95% CI: 1.466–1.735) showed significantly higher risks. The co-exposed group, characterized by both high ACEs and hypertension, exhibited the greatest risk of CVD (pooled HR = 2.010, 95% CI: 1.736–2.327). A clear dose-response relationship was observed, with CVD risk progressively increasing with greater ACEs exposure regardless of hypertension status. No significant additive or multiplicative interaction between ACEs and hypertension was identified. CONCLUSIONS: Co-exposure to ACEs and hypertension conferred substantially greater CVD risk than either factor alone. Integrating psychosocial adversity with traditional clinical measures enhanced CVD risk prediction, highlighting the importance of comprehensive assessment for early identification among middle-aged and older adults.