Elevated blood pressure during early adulthood was associated with a higher risk for heart and kidney diseases in midlife, according to a new study, confirming the wisdom of guidelines recommending treatment for young adults with hypertension.

In the study presented at the American Heart Association’s EPI Lifestyle Scientific Sessions 2026 on March 20, patients with systolic blood pressure that stayed around 10 mm Hg higher than that of their peers over a 10-year period had a 27% increased risk for heart disease and a 22% increased risk for kidney disease.

A Data Gap in Young Adults

“The 2025 American Heart Association blood pressure guideline recommends early treatment of stage 1 hypertension, after 3-6 months of lifestyle modification in people with low predicted 10-year risk of cardiovascular disease,” said Hokyou Lee, MD, PhD, an associate professor of preventive medicine at Yonsei University College of Medicine in Seoul, South Korea. “Unfortunately, there are no cardiovascular outcomes trial data to support this recommendation in younger populations.”

Lee and his collaborators sought to fill that data gap by analyzing medical records of nearly 300,000 adults from the Korean National Health Insurance Service Database. The adults were 30 years old between 2002 and 2004 and had received routine health screenings from age 30 to 40. To be included in the analysis, patients must not have had a prior history of heart or kidney disease before age 40.

High Pressure Over Time

Nearly half of the US adults are living with high blood pressure, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, and it’s the most common major risk factor for cardiovascular disease.

Lee noted that long-term elevated blood pressure creates cumulative mechanical stress on the vessel walls, leading to vascular remodeling, arterial stiffness, and endothelial dysfunction, which accelerate serious heart conditions such as atherosclerosis, left ventricular hypertrophy, and heart failure.

“At the same time, elevated systemic pressure is transmitted to glomerular capillaries, causing hyperfiltration, podocyte injury, and progressive glomerulosclerosis,” he said. “Even modest but persistent elevations can accumulate organ damage and increase the risk of clinical events.”

In the study, when lifestyle factors such as smoking and alcohol consumption were adjusted for, the association between higher blood pressure and later heart and kidney outcomes was “attenuated but remained significant,” Lee said, “implying independent association of cumulative blood pressure with outcomes.”

Cardiovascular Wear and Tear

“In the past, the blood pressure guideline has not recommended treating young adults with stage 1 hypertension with medication but recommended only lifestyle therapy,” said Daniel W. Jones, MD, a past president of the American Heart Association. “This study confirms the decision by my colleagues and I when we crafted the 2025 AHA/ACC [American Heart Association/American College of Cardiology] blood pressure guideline that medication should be prescribed for individuals with stage 1 hypertension if the blood pressure goal is not met within 3-6 months of lifestyle therapy alone.”

Jones, who was not involved with the study, called it “well done” and “credible in every way.” He compared cumulative blood pressure risk to loss of tread on a car tire. “If the car only travels 50 miles per day, each day, little wear is noted on the tire,” he said. “But if the tire has 50 miles of wear per day, every day, for 20 years, the tread will be lost completely. In the same way, it’s the cumulative burden on blood vessels that causes disease from high blood pressure.”

Jones called for further randomized controlled trials in young adults to confirm the benefit of treatment in lowering risk but noted such studies are challenging because of the cost.

“In the meantime, our guideline-writing committee for the 2025 guideline carefully reviewed and determined that the evidence from randomized, controlled trials in older adults can be extrapolated to younger patients,” he said. “This study affirms that extrapolation to be correct.”

The study authors disclosed having no relevant financial relationships.

Catherine Shaffer is a freelance science and medical writer with a background in molecular biology and pharmaceutical research. Her work has appeared extensively in scientific trade and mainstream publications and on public radio.