Antihypertensive treatment in young adults and cardiovascular risk: a population-based cohort study

Background and Aims The efficacy of antihypertensive drug treatment in reducing hypertension-related outcomes has been documented in old and middle age but never in younger individuals. The aim of this study was to assess the protective effect of antihypertensive drugs in young adults (18-39 years) by comparing the risk of nonfatal and fatal outcomes in patients with different adherence to antihypertensive drugs. Analysis was extended to middle-aged patients (40-55 years) for comparison. Methods Using the healthcare utilization database of the Lombardy region (Italy), 286 751 residents, aged 18-55 years, who were newly prescribed antihypertensive drugs between 2009 and 2017 were identified. Adherence to drug therapy was measured by the proportion of the follow-up covered by antihypertensive drug prescription, and data were compared for adherent vs non-adherent patients, i.e. drug coverage >= 80% vs <80% of the follow-up duration. The primary outcome was hospital admissions for cardiovascular (CV) events. Secondary outcomes were CV and all-cause death. Cox and the cause-specific hazard regression models were used to estimate hazard ratio (HR) and 95% confidence interval (CI). Results Over a follow-up of about 6 years, the HR of hospitalization for a CV outcome associated with adherence to antihypertensive drugs was 0.78 (95% CI 0.65-0.94) and 0.80 (95% CI 0.76-0.84) among patients aged 18-39 and 40-55 years, respectively. Adherence to antihypertensive drugs was negatively associated with CV and all-cause mortality in the older group (-18%, 6-28%; -30%, 27-33%), while showing no significant effects on these outcomes in the younger one. Conclusions In a real-life setting, adherence to antihypertensive drug treatment reduced CV risk in young adults as much as in middle-aged patients.