Risk factors for hypertension in young adults: evidence from a cross-sectional and cohort study at the Aerospace Wuxi Health Management Center

Objective To explore the risk factors of hypertension in young adults aged 18–45 years and provide evidence for effective management strategies.

Methods A total of 143 898 young adults who underwent health check-ups at the Aerospace Wuxi Health Management Center from January 2014 to December 2023 were included in the study. Logistic regression analysis was conducted for a cross-sectional study to preliminarily identify the factors associated with hypertension prevalence. After excluding individuals without follow-up data and those diagnosed with hypertension at baseline, 24 076 participants were included in follow-up study using a Cox proportional hazards model to further investigate risk factors for incident hypertension.

Results The cross-sectional study indicated a hypertension prevalence of 15.57% (22 399/143 898) in this population. Risk factors of hypertension included older age, male gender, body mass index (BMI) ≥24 kg/m², elevated waist-to-hip ratio, heart rate ≥100 beats per minute, triglycerides (TG) ≥1.7 mmol/L, low density lipoprotein cholesterol (LDL-C) ≥3.4 mmol/L, fasting blood glucose ≥6.1 mmol/L, serum uric acid ≥420 μmol/L, estimated glomerular filtration rate (eGFR)＜90 mL/(min·1.73 m²), and a family history of hypertension. In the cohort study, the median follow-up period was 2.951 years, during which 4 383 participants developed hypertension, with an incidence density of 44.73 per 1 000 person-years. Risk factors significantly associated with incident hypertension included age, male gender, current or former smoking, BMI ≥24 kg/m², elevated waist-to-hip ratio, heart rate ≥100 beats per minute, TG ≥1.7 mmol/L, LDL-C ≥3.4 mmol/L, fasting blood glucose ≥6.1 mmol/L, serum uric acid ≥420 μmol/L, and a family history of hypertension. Both the cross-sectional study and cohort study identified differences in the distribution and impact of risk factors across genders (P_interaction＜0.05).

Conclusions Advancing age, male gender, and a family history of hypertension are non-modifiable risk factors for the development or presence of hypertension in young adults. Modifiable metabolic factors, including increased body weight, dysregulated glucose and lipid metabolism, hyperuricemia, impaired renal function, and elevated heart rate, are significant contributors to hypertension risk. Furthermore, the risk associated with certain factors may differ by gender.