Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, contributing significantly to the global burden of non-communicable diseases (1). Traditionally regarded as a condition of older adults, recent epidemiological trends suggest an alarming rise in the incidence of elevated blood pressure among younger populations, particularly those aged 18 to 35 years (2,3). The early onset of hypertension is especially concerning due to its prolonged exposure period, which increases the lifetime risk of end-organ damage and cardiovascular events such as myocardial infarction and stroke (4).

Multiple factors contribute to the development of hypertension in young adults, including genetic predisposition, dietary habits, sedentary lifestyles, psychosocial stress, and the increasing prevalence of obesity (5,6). Despite growing awareness, hypertension in this age group often remains underdiagnosed and poorly managed due to low screening rates and limited perception of personal risk (7). Moreover, asymptomatic presentation in the early stages further delays diagnosis and intervention (8).

Understanding the current prevalence and associated risk factors of hypertension among young adults is essential for designing effective preventive strategies. However, most existing literature is focused on middle-aged or elderly populations, with relatively fewer studies targeting the younger demographic (9). This study aims to determine the prevalence of hypertension among young adults in an urban setting and identify the key behavioral and clinical factors contributing to its development.

A total of 500 individuals were selected using stratified random sampling from colleges, workplaces, and community centers. Participants who had known cardiovascular diseases, were on antihypertensive medication, or declined consent were excluded.

Data collection was done using a pre-validated, structured questionnaire that included sociodemographic information, lifestyle habits (such as smoking, alcohol use, physical activity), dietary patterns (especially salt intake), and family history of hypertension.

Blood pressure was measured using a standardized digital sphygmomanometer after the participant had rested for at least five minutes. Two readings were taken five minutes apart in a seated position, and the average was considered. Hypertension was defined as systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥80 mmHg, in accordance with the American College of Cardiology/American Heart Association guidelines (1).

Anthropometric measurements including height and weight were recorded using calibrated instruments. Body Mass Index (BMI) was calculated and classified based on WHO guidelines. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ).

Data were entered and analyzed using SPSS version 26.0. Descriptive statistics were used to summarize the baseline characteristics. The prevalence of hypertension was reported as percentages. Chi-square test and binary logistic regression were employed to identify associations between hypertension and potential risk factors. A p-value of <0.05 was considered statistically significant.

A total of 500 young adults participated in the study, comprising 280 males (56%) and 220 females (44%), with a mean age of 26.4 ± 4.8 years. The overall prevalence of hypertension was found to be 18.4% (n=92). Among these, stage 1 hypertension was identified in 67 participants (13.4%) and stage 2 hypertension in 25 participants (5.0%).

Table 1 presents the demographic distribution of the study population and the prevalence of hypertension according to gender, BMI, and lifestyle variables. The prevalence was significantly higher in males (22.1%) compared to females (14.1%) (p = 0.03).

Table 1: Distribution of Hypertension According to Demographic and Lifestyle Factors (n = 500)

*Statistically significant

As shown in Table 2, multivariate logistic regression analysis revealed that overweight status (OR = 2.8, 95% CI: 1.7–4.4), sedentary lifestyle (OR = 2.5, 95% CI: 1.5–3.9), family history of hypertension (OR = 2.1, 95% CI: 1.3–3.3), and high dietary salt intake (OR = 3.2, 95% CI: 2.0–5.0) were significant independent predictors of hypertension (p < 0.05).

Table 2: Logistic Regression Analysis of Risk Factors Associated with Hypertension

*Statistically significant

In summary, the study identified a notable prevalence of hypertension among young adults, with modifiable lifestyle factors playing a prominent role in its development (Tables 1 and 2).

This cross-sectional study revealed that approximately 18.4% of young adults aged 18–35 years were hypertensive, aligning with recent findings that suggest hypertension is no longer confined to older populations (1,2). Our results underscore a growing public health concern, particularly as early-onset hypertension is strongly associated with a higher lifetime risk of cardiovascular disease and target organ damage (3,4).

Male participants exhibited a significantly higher prevalence of hypertension compared to females, consistent with earlier studies attributing this disparity to hormonal, behavioral, and lifestyle factors such as smoking, alcohol intake, and reduced healthcare engagement among men (5,6). Obesity emerged as a key independent predictor, with overweight individuals nearly three times more likely to be hypertensive. This finding echo previous research highlighting the strong link between elevated BMI and increased vascular resistance and sympathetic nervous system activation (7,8).

Our study also identified high dietary salt intake and sedentary lifestyle as significant modifiable risk factors. Participants consuming more than 5 grams of salt daily had a more than threefold increase in hypertension risk, which concurs with WHO recommendations and previous epidemiological data from both Western and Asian cohorts (9,10). Similarly, physical inactivity doubled the odds of developing hypertension, consistent with literature affirming the benefits of regular aerobic exercise in maintaining normotensive states (11,12).

Family history was another important determinant, reinforcing the genetic and familial aggregation of blood pressure traits (13). This emphasizes the need for targeted screening in individuals with a positive family history, even in the absence of symptoms.

Interestingly, while smoking and alcohol use were more prevalent in the hypertensive group, they did not achieve statistical significance in multivariate analysis. This may be due to underreporting, smaller sample sizes for these subgroups, or confounding factors. However, both have been implicated in endothelial dysfunction and long-term cardiovascular risk in several large-scale studies (14,15).

The cross-sectional design of our study limits the ability to establish causality, and recall bias cannot be entirely excluded due to the use of self-reported questionnaires. Nevertheless, the sample size and methodological rigor strengthen the internal validity of our findings.

In light of the observed trends, there is a pressing need for early intervention strategies focusing on lifestyle modification, regular blood pressure screening, and awareness programs tailored for the younger population. Future longitudinal studies could help establish causal pathways and evaluate the effectiveness of preventive strategies initiated in early adulthood.

This study highlights a significant prevalence of hypertension among young adults, with key risk factors including male gender, obesity, high salt intake, sedentary lifestyle, and family history. These findings emphasize the need for early screening and targeted lifestyle interventions to prevent long-term cardiovascular complications in this age group.

1. Ahammed B, Maniruzzaman M, Talukder A, Ferdausi F. Prevalence and risk factors of hypertension among young adults in Albania. High Blood Press Cardiovasc Prev. 2021;28(1):35-48.
2. Abariga SA, Khachan H, Al Kibria GM. Prevalence and determinants of hypertension in India based on the 2017 ACC/AHA guideline: evidence from the India National Family Health Survey. Am J Hypertens. 2020;33(3):252-260.
3. Mirzaei M, Mirzaei M, Mirzaei M, Bagheri B. Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017. BMC Cardiovasc Disord. 2020;20(1):372.
4. Das Gupta R, Bin Zaman S, Wagle K, Crispen R, Hashan MR, Al Kibria GM. Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016. BMJ Open. 2019;9(8):e030206.
5. Poudel B, Booth JN 3rd, Sakhuja S, Moran AE, Schwartz JE, Lloyd-Jones DM, et al. Prevalence of ambulatory blood pressure phenotypes using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds: data from the Coronary Artery Risk Development in Young Adults study. J Hypertens. 2019;37(7):1401-1410.
6. McEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, et al. Association of isolated diastolic hypertension as defined by the 2017 ACC/AHA blood pressure guideline with incident cardiovascular outcomes. JAMA. 2020;323(4):329-338.
7. Marchesan LB, Spritzer PM. ACC/AHA 2017 definition of high blood pressure: implications for women with polycystic ovary syndrome. Fertil Steril. 2019;111(3):579-587.e1.
8. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137(2):109-118.
9. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, et al. Potential U.S. population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol. 2018;71(2):109-118.
10. Kibria GMA, Swasey K, Choudhury A, Burrowes V, Stafford KA, Uddin SMI, et al. The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh. J Hum Hypertens. 2018;32(8-9):608-616.
11. Opoku S, Addo-Yobo E, Trofimovitch D, Opoku RB, Lasong J, Gan Y, et al. Increased prevalence of hypertension in Ghana: new 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application. J Glob Health. 2020;10(2):020408.
12. Rana J, Ahmmad Z, Sen KK, Bista S, Islam RM. Socioeconomic differentials in hypertension based on JNC7 and ACC/AHA 2017 guidelines mediated by body mass index: evidence from Nepal demographic and health survey. PLoS One. 2020;15(1):e0218767.
13. Kibria GMA, Swasey K, Kc A, Mirbolouk M, Sakib MN, Sharmeen A, et al. Estimated change in prevalence of hypertension in Nepal following application of the 2017 ACC/AHA guideline. JAMA Netw Open. 2018;1(3):e180606.
14. Hussain A, Virani SS, Zheng L, Gluckman TJ, Borden WB, Masoudi FA, et al. Potential impact of 2017 American College of Cardiology/American Heart Association hypertension guideline on contemporary practice: a cross-sectional analysis from NCDR PINNACLE Registry. J Am Heart Assoc. 2022;11(11):e024107.
15. Li S, Schwartz JE, Shimbo D, Muntner P, Shikany JM, Booth JN 3rd, et al. Estimated prevalence of masked asleep hypertension in US adults. JAMA Cardiol. 2021;6(5):568-573.