A generation of young military veterans — roughly half a million — is carrying a middle-aged disease burden, and of those, nearly half are estimated to have undiagnosed high blood pressure.

Those are the findings of a large cross-sectional study, published in the Journal of the American Heart Association, looking at the prevalence of hypertension in the youngest veterans discharged post-9/11. The average age of these veterans was 33.5 years.

“Hypertension prevalence, diagnosis, and treatment vary by age, sex, and race and ethnicity in the general US population, and for veterans, less is known about the youngest veterans, including growing subsets of women and some racial and ethnic subgroups,” the study authors wrote.

Cardiovascular disease (CVD) risk also seems to be hitting young adults in the general population.

“CVD risk factors are increasing among young individuals — this is undeniably true. There is less physical activity than prior generations, more screen time, and greater access to processed and ultra-processed food — all of which increase the risk of disease such as hypertension,” said Luke J. Laffin, MD, co-director for the Center for Blood Pressure Disorders at the Cleveland Clinic in Cleveland.

While multiple ongoing and recent studies are exploring why hypertension and CVD risk are rising in younger adults, this report is one of the first large national studies focused on young post-9/11 veterans.

Study Methodology

Researchers used national Veterans Health Administration data to identify post-9/11 veterans receiving Veterans Health Administration care from 2001 to 2023. 

The analysis included 1.18 million participants. Of the group, 12.3% were women. The analysis adjusted for key demographic and clinical factors, including age, marital status, and whether veterans lived in urban or rural areas. 

Measures of health care access included insurance status and the number of primary care visits. Clinical factors included BMI, smoking status, hyperlipidemia, and comorbid conditions such as posttraumatic stress disorder, sleep apnea, diabetes, and substance use. A history of military sexual trauma was also included.

Study participants had clinical hypertension, antihypertensive medication fills, or blood pressure measurements (≥ 140/90 mm Hg) on at least two occasions; undiagnosed hypertension; and untreated hypertension. These three measures — clinical hypertension, undiagnosed hypertension, and untreated hypertension — were analyzed as yes/no outcomes for the primary analysis. 

The Undiagnosed Problem

Nearly half of this cohort (44.9%) had hypertension — yet about half were undiagnosed, and one-quarter (26%) were untreated. Women were slightly less likely than men to have hypertension and were far less likely to be untreated. Even so, 17% more likely to have an undiagnosed disease.

Black veterans had a higher burden of hypertension than White veterans but were less likely to go undiagnosed or untreated, pointing to a paradox of greater disease burden but better recognition and management once hypertension develops. 

Compared with White veterans, Hispanic veterans had a lower likelihood of hypertension overall (adjusted prevalence ratio [aPR], 0.90) but were more likely to have undiagnosed (aPR, 1.05) and untreated hypertension (aPR, 1.07), highlighting persistent gaps in recognition and management.

Also notable is the median time to hypertension after the first Veterans Health Administration visit was a little under 2 years (1.9), suggesting not only rapid cardiometabolic deterioration but also a missed window of early prevention.

Tiffany Chang, PhD, epidemiologist at the Centers for Disease Control and Prevention in Atlanta and first author of the study, said that despite the troubling data, there are ways that this population can immediately take steps to help prevent cardiac events. 

“These findings highlight an important gap in the prevention and management of high blood pressure, but public health professionals can work with clinicians and decision makers to support tailored interventions,” she said. “For example, the use of self-measured blood pressure monitoring programs with clinical support can improve blood pressure control and, in turn, help reduce CVD risk and improve health outcomes for younger veterans.”

Recognition Is Key

The study points to a combination of clinical risk and system-level gaps to explain the findings. Post-9/11 veterans carry a high burden of hypertension risk factors, including obesity, smoking, sleep apnea, and posttraumatic stress disorder, and appear to develop hypertension relatively quickly after entering care.

At the same time, the large proportion of undiagnosed cases suggests that many patients are “hiding in plain sight,” with elevated blood pressure or treatment present but no formal diagnosis documented in the medical record.

Untreated hypertension may reflect both missed opportunities for care and the tendency to manage younger patients conservatively with lifestyle changes before initiating medication.

Notably, women — despite having a lower overall burden of hypertension — were significantly more likely to have undiagnosed disease, pointing to potential gaps in recognition or attribution of elevated blood pressure. Hispanic veterans showed a different pattern, with lower prevalence but a higher likelihood of undiagnosed and untreated hypertension. This underscores the persistent disparities in detection and management.

The researchers hypothesized that medications may be used for other disorders, such as migraines, or reflect gaps in clinical documentation.

Chang reported having no relevant financial disclosures. Laffin reported being a consultant on the steering committee for Recor, Medtronic, Eli Lilly, Mineralys, CRISPR Therapeutics, Novartis, Novo Nordisk, Ripple Medical, and Stability Health; receiving grant funding from AstraZeneca, Arrowhead, Retension, and Kardigan; and receiving royalties from Belvoir Media Group, and Elsevier. 

Lois Anzelowitz Levine is a lifestyle and medical writer in Dallas.