Sex Differences in Hypertension Diagnosis Among Young Adults in a US Integrated Health Care System

Young adults, especially men, may experience delays in hypertension diagnosis, treatment, and control. We estimated the time to first diagnosis of hypertension in young adults by sex and identified factors associated with hypertension diagnosis.

Using electronic health records from Kaiser Permanente Southern California, we identified adults, aged 18 to 39 years, without history of hypertension, and with high blood pressure (BP) (systolic BP ≥140 or diastolic BP ≥90 mm Hg), based on an average of 3 BPs from separate, consecutive outpatient visits within 2 years of each other between 2009 and 2016 and followed through 2019. We estimated the time to first hypertension diagnosis and identified factors associated with diagnosis using Cox proportional hazards models.

Among 2443 young adults (mean age, 31 years; 57% men) with high BP, 37% were diagnosed with hypertension during a median of 5.9 years. Delays in hypertension diagnosis were observed for both men and women, with a median of 1.8 years to diagnosis. Compared with women, men received their diagnoses later (percentage of diagnosis: 30% versus 47%; median time to diagnosis: 2.3 versus 1.4 years). Following their diagnosis, 80% initiated antihypertensive medications within 1 year. Factors associated with a delayed diagnosis of hypertension included being a man, being younger, having lower BP, having a lower body mass index, and the absence of dyslipidemia or (pre)diabetes.

Young adults, especially men, are at a high risk of delayed hypertension diagnosis, emphasizing the need for health care system-level interventions to improve the recognition, diagnosis, and treatment of hypertension in this population.