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Early onset of hypertension and increased relative risks of chronic kidney disease and mortality: two population-based cohort studies in United Kingdom and Hong Kong

Hypertension Research volume 48, pages 1963–1971 (2025)Cite this article

Abstract

This study aimed to evaluate the association between hypertension (HT) onset age and later risks of chronic kidney diseases (CKD) and mortality. Adult patients without CKD from 2008 to 2013 were identified using electronic medical records from United Kingdom (UK) and Hong Kong (HK). Patients newly diagnosed with HT and those without were included in the HT and control groups, respectively. All subjects were stratified into six age groups (18-39, 40-49, 50-59, 60-69, 70-79, ≥80). Multivariable Cox proportional hazard regression, adjusted with baseline characteristics and fine stratification weights, was conducted to investigate the association between HT onset and risks of CKD, renal decline, end-stage renal disease (ESRD), and all-cause mortality. Subjects were followed up from baseline until an outcome event, death, or administrative end of the cohort, whichever occurred first. A total of 4,413,551 and 3,132,951 subjects were included in the UK and HK cohorts, respectively. HT was significantly associated with increased risks of outcome, but the hazard ratios (HRs) decreased with increasing onset age. In the UK cohort, the HRs (95% confidence intervals) for subjects aged 18-39 and ≥80 were 3.69 (3.53, 3.86) and 2.01 (1.96, 2.06) for CKD, 3.83 (3.60, 4.07) and 3.17 (2.97, 3.38) for renal decline, 17.26 (14.34, 20.77) and 2.55 (2.12, 3.07) for ESRD, 2.88 (2.66, 3.11) and 1.09 (1.07, 1.12) for mortality. The HK cohort exhibited a similar pattern. Our study concluded that early onset of HT significantly affects renal health later in life, while the contribution decreases with the onset age of HT.

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Data availability

The electronic medical records used in the current study are provided by the Hospital Authority of Hong Kong and IQVIA. The data can be accessed upon request to the Hospital Authority of Hong Kong and IQVIA.

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Acknowledgements

The authors wish to acknowledge the Hong Kong Hospital Authority for its contributions to data extraction. The computations were performed using research computing facilities offered by Information Technology Services at the University of Hong Kong.

Funding

This study was supported by Excellent Young Scientists Fund, National Natural Science Foundation of China (Principal Investigator: Eric Yuk Fai Wan; Ref No. 82222902), and the Start-up Fund of the University of Hong Kong (Principal Investigator: Eric Yuk Fai Wan). The funders have no role in the study design, data collection, data analysis, interpretation, and report drafting. The corresponding authors had full access to all the data in the study and took final responsibility for the decision to submit for publication.

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Author notes

  1. These authors contributed equally: Kiki SN Liu, Boyuan Wang

Authors and Affiliations

  1. Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China

    Kiki SN Liu, Boyuan Wang, Ivy L Mak, Cindy LK Lam & Eric YF Wan

  2. School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China

    Edmond PH Choi

  3. Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China

    Cindy LK Lam

  4. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China

    Eric YF Wan

  5. The Institute of Cardiovascular Science and Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China

    Eric YF Wan

  6. Advanced Data Analytics for Medical Science (ADAMS.) Limited, Hong Kong S.A.R., China

    Eric YF Wan

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  1. Kiki SN Liu
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Contributions

Concept and design: KSNL, BYW, CLKL, EYFW. Acquisition of data: CLKL, EYFW. Drafting of the manuscript: KSNL, BYW. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis, or interpretation of data: BYW, EYFW. Administrative, technical, or material support: CLKL, EYFW. Supervision: EYFW.

Corresponding author

Correspondence to Eric YF Wan.

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Conflict of interest

EYFW has received research grants from the Health Bureau of the Government of the Hong Kong Special Administrative Region, the Hong Kong Research Grants Council of the Government of the Hong Kong SAR, Narcotics Division, Security Bureau of the Government of the Hong Kong SAR, Social Welfare Department, Labour and Welfare Bureau of the Government of the Hong Kong SAR and National Natural Science Foundation of China, outside the submitted work. CLKL has received research grants from the Health Bureau of the Government of the Hong Kong SAR, the Hong Kong Research Grant Council, the Hong Kong College of Family Physicians, and Kerry Group Kuok Foundation, outside the submitted work. The remaining authors have nothing to disclose.

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Liu, K.S., Wang, B., Mak, I.L. et al. Early onset of hypertension and increased relative risks of chronic kidney disease and mortality: two population-based cohort studies in United Kingdom and Hong Kong. Hypertens Res 48, 1963–1971 (2025). https://doi.org/10.1038/s41440-025-02188-x

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