Hypertension in young adults and exploring its role in sudden cardiac death: expert opinion from India
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20262823Keywords:
Hypertension, Sudden cardiac death, β-blockers, Young adult, Angiotensin receptor blockers, Fixed-dose combination, Bisoprolol, TelmisartanAbstract
Hypertension, once considered a disease affecting older adults, is now alarmingly increasing in young Indian adults. Several lifestyle and environmental factors are linked to this sudden increase in hypertension in young adults in both urban and rural settings. However, there is a lack of guideline recommendations and clinical trial data for managing hypertension in young adults and adolescents, leaving clinicians with a lack of recommendation-based treatment for this population. Five focused group discussions including 60 eminent cardiologists from India were conducted to understand their perspectives on the approach to management of hypertension in young adults and whether it is linked to sudden cardiac death (SCD), particularly in those with left ventricular hypertrophy. Prevention of SCD in young adults, risk factors, and challenges in the early diagnosis and management approach for young adults with hypertension were also discussed. This review provides an overview of relevant literature and summarizes the perspectives of Indian experts on the merits of the fixed-dose combination of telmisartan plus bisoprolol that has shown promise in controlling hypertension in young adults.
References
World Health Organization. First WHO report details devastating impact of hypertension and ways to stop it. 2023. Available at: https://www.who.int/news/ item/19-09-2023-first-who-report-details-devastatin g-impact-of-hypertension-and-ways-to-stop-it. Accessed on 21 May 2026.
National Family Health Survey (Nfhs-5) 2019–21. Available at: https://dhsprogram.com/pubs/pdf/ FR375/FR375.pdf. Accessed on 21 May 2026.
Gupta R, Gaur K, Ahuja S, Anjana RM. Recent studies on hypertension prevalence and control in India 2023. Hypertens Res. 2024;47(6):1445-56. DOI: https://doi.org/10.1038/s41440-024-01585-y
Premanath M. Sudden Cardiac Death – Can it be Prevented? APIK J Internal Med. 2024;12:250-2. DOI: https://doi.org/10.4103/ajim.ajim_30_24
Ha ACT, Doumouras BS, Wang C (Nancy), Tranmer J, Lee DS. Prediction of Sudden Cardiac Arrest in the General Population: Review of Traditional and Emerging Risk Factors. Canad J Cardiol. 2022;38(4):465-78. DOI: https://doi.org/10.1016/j.cjca.2022.01.007
Osman J, Tan SC, Lee PY, Low TY, Jamal R. Sudden Cardiac Death (SCD) – risk stratification and prediction with molecular biomarkers. J Biomed Sci. 2019;26:39. DOI: https://doi.org/10.1186/s12929-019-0535-8
Pan H, Hibino M, Kobeissi E, Aune D. Blood pressure, hypertension and the risk of sudden cardiac death: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol. 2020;35(5):443-54. DOI: https://doi.org/10.1007/s10654-019-00593-4
Faduyile F, Soyemi S, Sanni D, Wright K. Hypertension and Sudden Unexpected Deaths: An Autopsy Study of Four Hundred and Seventy-Seven Brought-in-Dead in a Tertiary Health Center. Niger Med J. 2019;60:13. DOI: https://doi.org/10.4103/nmj.NMJ_6_19
NICE. Hypertension in adults: diagnosis and management. 2019. Available at: https://www.nice. org.uk/guidance/ng136. Accessed on 21 May 2026.
Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874. DOI: https://doi.org/10.1097/HJH.0000000000003480
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324. DOI: https://doi.org/10.1161/HYP.0000000000000066
Shah SN, Munjal YP, Kamath SA, Wander GS, Mehta N, Mukherjee S, et al. Indian guidelines on hypertension-IV (2019). J Hum Hypertens. 2020;34(11):745-58.
Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). The Lancet Diabetes Endocrinol. 2023;11(7):474-89. DOI: https://doi.org/10.1016/S2213-8587(23)00119-5
Ravindranath R, Sarma PS, Sivasankaran S, Thankappan KR, Jeemon P. Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India. Front Public Health. 2024;12. DOI: https://doi.org/10.3389/fpubh.2024.1375227
Sobierajski T, Surma S, Romańczyk M, Łabuzek K, Filipiak KJ, Oparil S. What Is or What Is Not a Risk Factor for Arterial Hypertension? Not Hamlet, but Medical Students Answer That Question. Int J Environ Res Public Health. 2022;19(13):8206. DOI: https://doi.org/10.3390/ijerph19138206
Meher M, Pradhan S, Pradhan SR. Risk factors associated with hypertension in young adults: a systematic review. Cureus 2023;15(4):e37467. DOI: https://doi.org/10.7759/cureus.37467
Brown J, Yazdi F, Jodari-Karimi M, Owen JG, Reisin E. Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship. Curr Hypertens Rep. 2022;24(6):173-84. DOI: https://doi.org/10.1007/s11906-022-01181-w
Prenissl J, Manne-Goehler J, Jaacks LM, Prabhakaran D, Awasthi A, Bischops AC, et al. Hypertension screening, awareness, treatment, and control in India: A nationally representative cross-sectional study among individuals aged 15 to 49 years. PLoS Med. 2019;16(5):e1002801. DOI: https://doi.org/10.1371/journal.pmed.1002801
Raina R, Khooblall A, Shah R, Vijayvargiya N, Khooblall P, Sharma B, et al. Cardiovascular implications in adolescent and young adult hypertension. Rev Cardiovasc Med. 2022;23(5):166. DOI: https://doi.org/10.31083/j.rcm2305166
Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Hu P. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study. PLoS Med. 2022;19(1):e1003855. DOI: https://doi.org/10.1371/journal.pmed.1003855
Krishnamoorthy Y, Rajaa S, Sulgante S, Chinnakali P, Jaswal N, Goel S. Prevalence of hypertension and determinants of treatment-seeking behaviour among adolescents and young adults in India: an analysis of NFHS-4. J Public Health (Oxf). 2022;45(1):e48-56. DOI: https://doi.org/10.1093/pubmed/fdac006
Jadhav U, Solanki D, Kumar S, Hazra P, Alexander T, Gupta A, et al. Obesity and sympathetic overactivity in young individuals with hypertension: clinical perspective of Indian healthcare providers. Cureus. 2024;16(11):e74115. DOI: https://doi.org/10.7759/cureus.74115
Julius S, Nesbitt S. Sympathetic overactivity in hypertension. A moving target. Am J Hypertens. 1996;9(11):113S-20S. DOI: https://doi.org/10.1016/0895-7061(96)00287-7
Padmanabhan TNC, Dani S, Chopra VK, Guha S, Vasnawala H, Ammar R. Prevalence of sympathetic overactivity in hypertensive patients – A pan India, non-interventional, cross sectional study. Indian Heart J. 2014;66(6):686-90. DOI: https://doi.org/10.1016/j.ihj.2014.10.421
Adua E. Decoding the mechanism of hypertension through multiomics profiling. J Hum Hypertens. 2023;37(4):253-64. DOI: https://doi.org/10.1038/s41371-022-00769-8
Verdecchia P, Angeli F, Cavallini C, Aita A, Turturiello D, De Fano M, et al. Sudden Cardiac Death in Hypertensive Patients. Hypertension. 2019;73(5):1071-8. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.119.12684
Tereshchenko LG, Soliman EZ, Davis BR, Oparil S. Risk stratification of sudden cardiac death in hypertension. Journal of Electrocardiology. 2017;50(6):798-801. DOI: https://doi.org/10.1016/j.jelectrocard.2017.08.012
McGorrian C, Yusuf S, Islam S, Jung H, Rangarajan S, Avezum A, et al. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score. Eur Heart J. 2011;32(5):581-9. DOI: https://doi.org/10.1093/eurheartj/ehq448
Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, et al. Hypertension. Nat Rev Dis Primers. 2018;4:18014. DOI: https://doi.org/10.1038/nrdp.2018.14
Madhavan SR, Reddy S, Panuganti PK, Joshi R, Mallidi J, Raju K, et al. Epidemiology of Sudden Cardiac Death in Rural South India - Insights From The Andhra Pradesh Rural Health Initiative. Indian Pacing Electrophysiol J. 2011;11(4):93-102.
Srivatsa UN, Swaminathan K, Sithy Athiya Munavarah K, Amsterdam E, Shantaraman K. Sudden cardiac death in South India: Incidence, risk factors and pathology. Indian Pacing Electrophysiol J. 2016;16(4):121-5. DOI: https://doi.org/10.1016/j.ipej.2016.10.004
Rao BH, Sastry BKS, Chugh SS, Kalavakolanu S, Christopher J, Shangula D, et al. Contribution of sudden cardiac death to total mortality in India — A population based study. Int J Cardiol. 2012;154(2):163-7. DOI: https://doi.org/10.1016/j.ijcard.2010.09.016
Rao BH. Global burden of Sudden Cardiac Death and insights from India. Indian Heart J. 2014;66(Suppl 1):S18-23. DOI: https://doi.org/10.1016/j.ihj.2013.11.009
Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, et al. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension. Eur J Int Med. 2024;126:1-15. DOI: https://doi.org/10.1016/j.ejim.2024.05.033
Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-46. DOI: https://doi.org/10.1093/eurheartj/ehac361
Shah SN, Munjal YP, Kamath SA, Wander GS, Mehta N, Mukherjee S, et al. Indian guidelines on hypertension-IV (2019). J Hum Hypertens. 2020;34(11):745-58. DOI: https://doi.org/10.1038/s41371-020-0349-x
Poulter N. ARBs in hypertension. Br J Cardiol 2010;17:s6-9.
DiPette DJ, Skeete J, Ridley E, Campbell NRC, Lopez‐Jaramillo P, Kishore SP, et al. Fixed‐dose combination pharmacologic therapy to improve hypertension control worldwide: Clinical perspective and policy implications. J Clin Hypertens (Greenwich). 2018;21(1):4-15. DOI: https://doi.org/10.1111/jch.13426
Jadhav U, Tiwaskar M, Khan A, Kalmath BC, Ponde CK, Sawhney J, et al. Hypertension in Young Adults in India: Perspectives and Therapeutic Options amongst Clinician’s in a Cross Sectional Observational Study. J Assoc Physicians India. 2021;69(11):11-2.
Alexander T, Hiremath JS, Swahney JPS, Chandra S, Jain P, Chandra P, et al. Identifying Drug Prescription in Newly Diagnosed Hypertension Patients in India. J Clin Hypertens (Greenwich). 2025;27(1):e14963. DOI: https://doi.org/10.1111/jch.14963
Channaraya V, Marya RK, Somasundaram M, Mitra D, Tibrewala KD. Efficacy and tolerability of a β-1 selective β blocker, bisoprolol, as a first-line antihypertensive in Indian patients diagnosed with essential hypertension (BRIGHT): an open-label, multicentric observational study. BMJ Open. 2012;2(3):e000683. DOI: https://doi.org/10.1136/bmjopen-2011-000683
Chen YD, Yang XC, Pham VN, Huang SA, Fu GS, Chen XP, et al. Resting heart rate control and prognosis in coronary artery disease patients with hypertension previously treated with bisoprolol: a sub-group analysis of the BISO-CAD study. Chin Med J (Engl). 2020;133(10):1155-65. DOI: https://doi.org/10.1097/CM9.0000000000000802
Chopra HK, Sethi KK, Nair T, Ponde C, Ray S, Rao S, et al. National Consensus Statement on Role of Bisoprolol across Cardiovascular Continuum: Special Focus on Women. J Assoc Physicians India. 2025;73(5):e16-33.
Feng Z, Zhang L, Wang Y, Guo H, Liu J. Efficacy and Safety of Bisoprolol in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis. 2023;18:3067-83. DOI: https://doi.org/10.2147/COPD.S438930
Manjula S, Krishna Kumar M. Expert Opinion on the use of Bisoprolol-Telmisartan Combination in Indian Patients with Hypertension. Indian J 02 Cardio Biol Clin Sci. 2024;7(1):113. DOI: https://doi.org/10.9734/ajcr/2024/v7i1223
Wander GS, Panda JK, Pal J, Mathur G, Sahay R, Tiwaskar M, et al. Management of hypertension in patients with type 2 diabetes mellitus: Indian guideline 2024 by Association of Physicians of India and Indian College of Physicians. J Assoc Physicians India. 2024;72(8):e1-e25. DOI: https://doi.org/10.59556/japi.72.0620
Downloads
Published
How to Cite
Issue
Section
