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Estimating the proportion of young adults on antihypertensive treatment that have been correctly diagnosed

Journal of Human Hypertension volume 22, pages 96–101 (2008)Cite this article

Abstract

This paper aims to identify how many young adults on antihypertensive treatment have been misclassified as hypertensive. We identified subjects aged under 35 on antihypertensive treatment, from the Health Surveys for England, 1998–2004. Pretreatment systolic and diastolic blood pressures were calculated by adjusting on-treatment blood pressures for the effects of treatment. Treatment effects were derived from meta-analysis. Subjects were classified as hypertensive if pretreatment blood pressure was ⩾160/100 mm Hg, or was ⩾140/90 mm Hg in conjunction with high cardiovascular risk. We then identified the proportion of treated subjects on antihypertensive treatment who were truly eligible for treatment. From the survey data we identified 65 adults (25 men and 40 women) under 35 on diuretics, β-blockers, angiotensin converting enzyme inhibitors, calcium blockers or other antihypertensives. Average pretreatment blood pressure was 164/100 mm Hg in those eligible for treatment, and 136/79 mm Hg in those not eligible. The analysis indicated that 29.2% of adults aged 16–34 (95% confidence interval (CI): 18.6–41.8%) were truly eligible for antihypertensive treatment: 32.0% (95% CI: 14.9–53.5%) of men and 25.0% (95% CI: 12.7–41.2%) of women. A total of 73.7% (14 of 19) of subjects eligible and 41.3% (19 of 46) of subjects not eligible for treatment either had a body mass index>30 kg m−2 or kidney disease (χ2-test P=0.018). Because of biological variation in blood pressure, most young adults on treatment for hypertension have been misclassified as hypertensive. Most who have been correctly diagnosed are either clinically obese or have kidney disease.

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Authors and Affiliations

  1. Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK

    T Marshall, R Tennant & W N Harrison

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  1. T Marshall
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  2. R Tennant
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  3. W N Harrison
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Correspondence to T Marshall.

Additional information

Contribution: Tom Marshall had the original idea. Ruth Tennant, Wayne N Harrison and Tom Marshall obtained the data, carried out the analysis and wrote the paper jointly.

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Appendix

Appendix

In meta-analysis, the average reduction in blood pressure was 8.8 mm Hg systolic and 4.4 mm Hg diastolic at standard dose of a thiazide (for example, bendroflumethiazide 2.5 mg). Drugs reduced blood pressure from all pretreatment levels, more so from higher levels; for a 10 mm Hg higher blood pressure, the reduction was 1.0 mm Hg systolic and 1.1 mm Hg diastolic greater.3 Average pretreatment blood pressure in the meta-analysis was 154/97 mm Hg. The effect of a standard-dose thiazide on systolic blood pressure is therefore given as 8.8+1.0 × (pretreatment systolic BP−154)/10. The effect of a standard-dose thiazide on diastolic blood pressure is therefore given as 8.8+1.1 × (pretreatment systolic BP−97)/10. Therefore, the effects of a standard-dose thiazide can be expressed as shown in Table A1.

Table a1 Effects of a standard dose thiazide on systolic and diastolic blood pressure
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The effects of each class of drug at half-standard dose, standard dose and high dose are shown in Table A2.

Table a2 Effects of antihypertensive drugs on blood pressure of 154/97 mm Hg
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Marshall, T., Tennant, R. & Harrison, W. Estimating the proportion of young adults on antihypertensive treatment that have been correctly diagnosed. J Hum Hypertens 22, 96–101 (2008). https://doi.org/10.1038/sj.jhh.1002291

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