Incident hypertension in young adults with a mild estimated glomerular filtration rate reduction

Background — Hypertension is a common, modifiable risk factor for cardiovascular disease with an increasing occurrence in young adults. We examined the association of lower‐than‐normal kidney function with incident hypertension in young adults (aged 18–39 years) compared with middle‐aged (aged 40–49 years) and older adults (aged 50–65 years).

Methods — We conducted a historical cohort study of 7.8 million individuals (3.7 million aged 18–39 years) using linked provincial health care data sets from Ontario, Canada, between 2008 and 2021. Cox models were used to examine the association of categorized estimated glomerular filtration rate (eGFR) (60–100 mL/min per 1.73 m2) and incident hypertension, stratified by age (18–39, 40–49, and 50–65 years).

Results — Among our cohort (mean age, 40.4 years; mean eGFR, 104.9 mL/min), a total of 170 905 (4.6%) individuals developed hypertension among young adults, compared with 279 937 (15.3%) in those aged 40 to 49 years and 588 195 (25.2%) in those aged 50 to 65 years. The adjusted rates of hypertension increased with an eGFR of <100 mL/min, increasing step wise as eGFR declined, and occurred at a higher relative eGFR in young adults compared with older age groups. Among young adults who developed hypertension, cardiovascular events were 6‐ to 10‐fold more common and were more likely with minor eGFR reductions.

Conclusions — Minor reductions in eGFR in younger adults are associated with new‐onset hypertension and a higher risk of cardiovascular consequences, suggesting early identification, monitoring, and management may be beneficial.