Mak Ivy Lynn, Wang Boyuan, Liu Kiki Sze Nga, Choi Edmond Pui Hang, Lam Cindy Lo Kuen, Wan Eric Yuk Fai
Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China.
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251350091. doi: 10.1177/21501319251350091. Epub 2025 Jul 16.
This study examines the association between the age of hypertension onset and the risks of cardiovascular diseases (CVD) and mortality.
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.
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.
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.
本研究探讨高血压发病年龄与心血管疾病（CVD）风险及死亡率之间的关联。
利用英国和香港（HK）公共医疗系统的电子病历进行了两项回顾性队列研究。纳入2008年1月1日至2013年12月31日期间接受公共卫生服务的成年人（≥18岁）。英国队列中在基线前被诊断患有CVD或在基线前转出医疗机构的患者被排除。高血压发病定义为高血压诊断（≥140/90 mmHg）或抗高血压药物处方。患者根据高血压发病情况进行分类，并根据发病年龄分为6个年龄组。应用倾向评分精细分层权重以确保组间平衡。使用多变量Cox比例风险回归分析来评估CVD风险、心血管死亡率和全因死亡率。
英国队列包括481791例新发高血压患者和3893134例对照，而香港队列包括552594例新发高血压患者和2548914例对照。高血压与CVD风险和死亡率增加相关，且随着发病年龄的增大而降低。在英国队列中，39岁及以下发病的高血压患者发生CVD和死亡的风险最高，调整后的风险比分别为（HR = 4.30，95%CI [3.98, 4.65]）和（HR = 2.86，95%CI [2.64, 3.10]）。对于80岁及以上发病的高血压患者，风险较低，CVD的调整后HR = 2.56，95%CI [2.45, 2.68]，死亡的调整后HR = 1.11，95%CI [1.09, 1.14]。在香港队列中观察到类似趋势。
高血压发病年龄越小，心血管事件和死亡风险越高，这凸显了对年轻人进行早期筛查和强化干预的必要性，以改善长期血压控制，减少心血管并发症和死亡，从而长期减轻公共医疗系统的慢性病负担。
