Are we missing hypertension in young adults?

In Australia, hypertension affects over one-third of adults. Although often associated with older age, high blood pressure is also common in young adults. 

For young adults, the concern is cumulative exposure. Elevated blood pressure over time causes vascular and end-organ damage to the heart, kidneys, arteries and brain, increasing the risk of cardiovascular disease and events. The earlier elevated blood pressure develops, the longer the exposure and the greater the potential risk.

Young adults with blood pressure ≥130 and/or 80 mmHg have a higher risk of future cardiovascular events, with increased cardiovascular disease risk seen even at systolic pressures of 120–129 mmHg before age 40.

In Australia, hypertension control remains poor across the population. More than 60% of adults do not achieve adequate blood pressure control. To address this major problem, the Federal Government launched the National Hypertension Taskforce in 2022, aiming to increase control to 70% by 2030. Its roadmap prioritises primary care management, as hypertension is the most managed condition by GPs in Australia. 

A goal of 70% control will be hard to reach without addressing young adult hypertension. 

Current Australian guidelines largely base treatment initiation on five-year absolute cardiovascular risk. Pharmacological treatment based on blood pressure alone, regardless of absolute risk, is recommended only when above 160/100 mmHg. Because age is an important determinant of absolute cardiovascular risk, most young adults will be classified as ‘low risk’, potentially missing opportunities for earlier lifestyle or pharmacological intervention. 

Measuring hypertension rates in young adults

Using data from the 2017–18 National Health Survey, we examined hypertension prevalence, detection, treatment and control among Australian adults aged 18–39 years.

We found that about 800,000 Australians aged 18–39 years have hypertension. But only 9.4% were diagnosed, 6.8% were treated and only 4.5% were effectively treated to what is now considered a conservative target of <140/90 mmHg. 

Outcomes were better among those who reported having their blood pressure checked in the previous two years: detection, treatment and control were 11.2%, 8.3% and 5.4%, respectively, compared with 0.9%, 0% and 0% among those without a recent check.

Some limitations need to be considered. Our analysis used 2017–18 data. The most recent ABS statistics (released in May 2026) indicate that 18.4% of adults aged 18–34 years with hypertension were controlled. However, these data are considered a break in series due to differences in medication data capture and should not be compared with previous cycles. Estimates also use the conservative <140/90 mmHg threshold for control, using the lower <130/80 mmHg treatment target recommended by many international guidelines would likely identify more young adults with uncontrolled hypertension. Also, this data does not distinguish primary from secondary hypertension, which is an important factor relevant in younger onset hypertension. Last, 32% of blood pressure measurements were missing and were imputed, but this is a standard approach for population health surveys. 

Why are young adults being missed?

Low engagement with health services may contribute to poor hypertension detection. Hypertension is usually asymptomatic and may be overlooked in young adults perceived as healthy. However, 83% of young adults in our study reported having their blood pressure checked recently, suggesting access to measurements is only part of the problem.

What happens after an elevated reading also matters. Rechecking blood pressure, confirmation of hypertension and treatment initiation in combination with lifestyle recommendations may be delayed, particularly if a young person appears to be at low cardiovascular risk.

International guidelines are taking a different approach. The 2025 American Heart Association/American College of Cardiology guidelines recommend pharmacological treatment after 3–6 months of lifestyle intervention in all adults whose blood pressure remains ≥130/80 mmHg. In the US, 60% of adults aged 18–39 years with hypertension are diagnosed, 50% are treated and 32% achieve blood pressure control.

The contrast raises an important question: should absolute cardiovascular risk remain the main driver of treatment decisions in young adults, or should greater consideration be given to lifetime exposure to elevated blood pressure?

The landscape is changing

Australian hypertension guidelines are being updated and are due for release in 2027. If these guidelines adopt the lower <130/80 mmHg treatment targets recommended internationally, this could further increase the proportion of young adults considered to have uncontrolled hypertension. The guideline updates also provide an opportunity to consider how hypertension is managed in young adults, including the role of absolute cardiovascular risk in treatment decisions and improving detection of secondary hypertension.

Technology may also change detection. Cuffless blood pressure technologies are increasingly embedded into consumer wearable devices, which are widely used by younger adults. While not recommended for diagnosis, these technologies and accompanying features may help identify young adults who would otherwise remain unaware and prompt confirmatory monitoring and clinical assessment.

Young adult hypertension may become more prevalent, driven in part by rising obesity and sedentary lifestyles. Globally, hypertension prevalence in children and adolescents doubled between 2000 and 2020. Blood pressure tracks from childhood into adulthood, so earlier onset could result in longer lifetime exposure and greater cardiovascular risk.

What can we do now?

1. Measure and follow up blood pressure. Regular measurement, including opportunistically during appointments, can identify elevated blood pressure early but needs to be followed by appropriate confirmation and management.
2. Make use of Heart Health Checks. Increasing uptake of Medicare-rebated Heart Health Checks among eligible adults aged ≥30 years provides an opportunity to improve hypertension detection and management.
3. Tailor risk communication. Discussion of both the short-term risk and the potential long-term benefits of maintaining a healthy blood pressure can support shared decision-making around lifestyle changes and medication. 
4. Use team-based approaches. Practice nurses and pharmacists can help identify elevated blood pressure in young adults and support follow-up and management.

Ritu Trivedi is a Postdoctoral Research Fellow at the Cardiovascular Monitoring Group at The University of Sydney.

Niamh Chapman is a Senior Research Fellow and leads the Health Equity and Hypertension Group at The University of Sydney. She is Heart Foundation Future Leader Fellow. 

Alta (Aletta E.) Schutte is SHARP Professor and Principal Theme Lead of Cardiac, Vascular and Metabolic Medicine in the Faculty of Medicine and Health at UNSW Sydney. She is also the Global Co-Director of the Cardiovascular Program and Head of the Blood Pressure Program at The George Institute for Global Health. She is a NHMRC Investigator Grant Leadership Fellow.

Dean S Picone is a Senior Research Fellow and leads the Cardiovascular Monitoring Group at The University of Sydney. He is a NHMRC Investigator Grant Emerging Leadership Fellow.

RT, NC and DSP declare no competing interests. AES has received speaker honoraria from Servier, AstraZeneca, Medtronic, Omron, Novo Nordisk, Sky Labs, and Roche and serves on scientific advisory boards for Medtronic, Roche/Alnylam, AstraZeneca, Servier, and Sky Labs.