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. 2025 Jan-Dec:16:21501319251350091.
doi: 10.1177/21501319251350091. Epub 2025 Jul 16.

The Impact of Hypertension Onset Age on the Risk of Cardiovascular Diseases and Mortality: Two 10-Year Retrospective Cohort Studies in the United Kingdom and Hong Kong

Ivy Lynn Mak  1 , Boyuan Wang  1 , Kiki Sze Nga Liu  1 , Edmond Pui Hang Choi  2 , Cindy Lo Kuen Lam  1   3 , Eric Yuk Fai Wan  1   4   5   6
Affiliations

The Impact of Hypertension Onset Age on the Risk of Cardiovascular Diseases and Mortality: Two 10-Year Retrospective Cohort Studies in the United Kingdom and Hong Kong

Ivy Lynn Mak et al. J Prim Care Community Health. 2025 Jan-Dec.

Abstract

Introduction: This study examines the association between the age of hypertension onset and the risks of cardiovascular diseases (CVD) and mortality.

Methods: Two retrospective cohort studies were conducted using electronic medical records from public healthcare systems in the UK and Hong Kong (HK). Adults (≥18 years) who attended public health services between January 1, 2008 and December 31, 2013 were included in the study. Patients diagnosed with CVD before baseline or who transferred out of practice before baseline in the UK cohort were excluded. Hypertension onset was defined as a diagnosis of hypertension (≥140/90 mmHg) or the prescription of anti-hypertensive medication. Patients were categorized based on hypertension onset and divided into 6 age groups based on onset age. Propensity score fine stratification weights were applied to ensure balance between groups. Multivariable Cox proportional hazards regression a was used to assess risks of CVD, cardiovascular mortality, and deaths.

Results: The UK cohort included 481 791 new-onset hypertension patients and 3 893 134 controls, while the HK cohort included 552 594 new-onset hypertension patients and 2 548 914 controls. Hypertension was associated with increased CVD and mortality risks, which decreased with older onset ages. In the UK cohort, hypertension onset at ≤39 years had the highest risks for CVD and deaths, with adjusted hazard ratios (HR = 4.30, 95% CI [3.98, 4.65] and HR = 2.86, 95% CI [2.64, 3.10]). For patients with hypertension onset at ≥80 years, risks were lower, with adjusted HR = 2.56, 95% CI [2.45, 2.68] for CVD and HR = 1.11, 95% CI [1.09, 1.14] for deaths. Similar trends were observed in the HK cohort.

Conclusion: Younger age of hypertension onset is associated with higher risks for cardiovascular events and mortality, highlighting the need for early screening and intensive interventions in younger adults to improve long-term blood pressure control and reduce cardiovascular complications and deaths, alleviating the chronic disease burden on the public healthcare system over the long term.

Keywords: cardiovascular disease; cohort study; hypertension; mortality; young-onset.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EYFW has received research grants from the Health Bureau, the Hong Kong Research Grants Council, Narcotics Division, Security Bureau, Social Welfare Department, Labour and Welfare Bureau of the Government of the Hong Kong SAR and National Natural Science Foundation of China; serves on member of Core Team for Expert Group on Drug Registration of Pharmacy and Poisons Board, and is the director of Advance Data Analytics for Medical Science (ADAMS) Limited (HK), outside of the submitted work. CLKL has received research grants from the Food and Health Bureau of the Government of the Hong Kong SAR, the Hong Kong Research Grant Council, the Hong Kong College of Family Physicians, and Kerry Group Kuok Foundation, outside of the submitted work. The remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
The associations between onset of hypertension and cardiovascular disease/mortality in different age groups using Cox regression. Hazard ratio with 95% confidence interval adjusted by age, gender, smoking status, diabetes mellitus, atrial fibrillation, peripheral vascular disease, amputation, dementia, lung disease, cumulative trauma disorder, peptic ulcer, liver, chronic kidney disease, hemiplegia, leukaemia, malignant lymphoma, cancer, the use of anti-diabetic drugs, lipid-lowering agents, and weighting. CVD was defined by coronary heart disease, heart failure, and stroke. Abbreviations: CI, confidence interval; CVD, cardiovascular disease.
Figure 2.
Figure 2.
Associations between new onset HT and risk of CVD and mortality within subgroups stratified by gender in the United Kingdom. Hazard ratio with 95% confidence interval adjusted by age, gender, smoking status, diabetes mellitus, atrial fibrillation, peripheral vascular disease, amputation, dementia, lung disease, cumulative trauma disorder, peptic ulcer, liver, chronic kidney disease, hemiplegia, leukaemia, malignant lymphoma, cancer, the use of anti-diabetic drugs, lipid-lowering agents, and weighting. CVD includes coronary heart disease, heart failure, and stroke. Abbreviations: CHD, coronary heart disease; CI, confidence interval; Coef, coefficient; CVD, cardiovascular diseases; HT, hypertension; HR, Hazard ratio.
Figure 3.
Figure 3.
Associations between new onset HT and risk of CVD and mortality within subgroups stratified by gender in Hong Kong. Hazard ratio with 95% confidence interval adjusted by age, gender, smoking status, diabetes mellitus, atrial fibrillation, peripheral vascular disease, amputation, dementia, lung disease, cumulative trauma disorder, peptic ulcer, liver, chronic kidney disease, hemiplegia, leukaemia, malignant lymphoma, cancer, the use of anti-diabetic drugs, lipid-lowering agents, and weighting. CVD includes coronary heart disease, heart failure, and stroke. Abbreviations: CHD, coronary heart disease; CI, confidence interval; Coef, coefficient; CVD, cardiovascular diseases; HT, hypertension; HR, Hazard ratio.
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