Hypertension awareness and control among young adults in the national longitudinal study of adolescent health

Abstract

Background: Young adults are less likely than older adults to be aware they have hypertension or to be treated for hypertension.

Objective: To describe rates of hypertension awareness and control in a cohort of young adults and understand the impact of health insurance, utilization of preventive care, and self-perception of health on rates of hypertension awareness and control in this age group.

Design and participants: Cross-sectional study of 13,512 young adults participating in Wave IV of the National Longitudinal Study of Adolescent Health in 2007-2008.

Main measures: We defined hypertension as an average of two measured systolic blood pressures (SBP) ≥ 140 mmHg, diastolic blood pressures (DBP) ≥ 90 mmHg, or self-report of hypertension. We defined hypertension awareness as reporting having been told by a health care provider that one had high blood pressure, and assessed awareness among those with uncontrolled hypertension. We considered those aware of having hypertension controlled if their average measured SBP was < 140 mmHg and DBP was < 90 mmHg.

Key results: Of the 3,303 young adults with hypertension, 2,531 (76%) were uncontrolled, and 1,893 (75%) of those with uncontrolled hypertension were unaware they had hypertension. After adjustment for age, sex, race/ethnicity, weight status, income, education, alcohol and tobacco use, young adults with uncontrolled hypertension who had (vs. didn't have) routine preventive care in the past 2 years were 2.4 times more likely (95% confidence interval [CI] 1.68-3.55) to be aware, but young adults who believed they were in excellent (vs. less than excellent) health were 64% less likely to be aware they had hypertension (OR 0.36, 95% CI 0.23-0.57). Neither preventive care utilization nor self-rated health was associated with blood pressure control.

Conclusions: In this nationally representative group of young adults, rates of hypertension awareness and control were low. Efforts to increase detection of hypertension must address young adults' access to preventive care and perception of their need for care.

Figure 1

Unweighted number and weighted percentage of young adults ages 24–32 years with hypertension^† who were aware^‡ but not currently measuring hypertensive (controlled)^§, aware but still hypertensive (uncontrolled)^§, and unaware and uncontrolled. Data from the National Longitudinal Study of Adolescent Health, 2007–2008. BP = blood pressure. †We defined hypertension an average measured systolic blood pressure ≥ 140 mmHg or an average measured diastolic blood pressure ≥ 90 mmHg or self-report of a history of hypertension. ‡Participants were asked, “Has a doctor, nurse, or other health care provider ever told you that you have/had high blood pressure or hypertension (if female, added ‘when you were not pregnant’)?” Those who answered “no” were considered unaware and those who answered “yes” were considered aware. §We defined blood pressure control as an average measured systolic blood pressure ≤ 140 mmHg and an average measured diastolic blood pressure ≤ 90 mmHg among those aware of having hypertension.