Hypertension Prevalence and Key Risk Factors among U.S. Young Adults (Aged 18 – 34): A Cross-Sectional Study on the Impact of Smoking, Vaping and Lifestyle Choices

Background: Hypertension is historically associated with older adults, but it is now increasingly prevalent among young adults in the United States which poses a significant public health concern. Nearly one in five young adults have hypertension, nonetheless the condition remains underdiagnosed and poorly managed due to low healthcare engagement and asymptomatic progression. The growing burden of hypertension in this demographic is largely influenced by modifiable lifestyle factors such as smoking, vaping, excessive alcohol consumption, poor dietary choices and socioeconomic and body-weight factors. While traditional cigarette smoking has been well-established as a risk factor, the increasing use of e-cigarettes (vaping) presents emerging concerns regarding its potential role in hypertension risk. This study examined the prevalence of hypertension among young adults and investigated the association between smoking, vaping, body mass index, socioeconomic status and lifestyle factors that contribute to elevated blood pressure. Methodology: This study employed cross-sectional research design, using the data from the National Health and Nutrition Examination Survey. A final sample of young adults between the ages of 18 to 34 years was selected by filtering the NHANES dataset. Blood pressure was measured following the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines which defines hypertension as systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥80 mmHg. Key variables included smoking, vaping, dietary habits, physical activity, alcohol consumption, body mass index and PIR which are self-reported and validated clinical measurements. The study applied descriptive statistics, chi-square test and binary logistic regression models to estimate hypertension prevalence and examined associations with modifiable risk factors with subgroup analyses to explore disparities across demographic groups. Results: The study found that 34.8% of young adults had hypertension, with higher prevalence among males and older age groups. Female gender, lower body mass index and higher socioeconomic status were independently associated with lower odds of hypertension and each additional year of age was associated with increased risk by approximately 5%. High sodium intake remained positively associated with hypertension whereas smoking, vaping, binge drinking and low physical activity did not show strong associations, though patterns were directionally consistent with existing literature. Discussions: These findings highlight the urgent need for early screening and preventive interventions to reduce hypertension rates among young adults. Public health strategies should address modifiable risk factors such as diet, weight management, physical activity and socioeconomic barriers while also considering demographic disparities. Longitudinal research is needed to establish causal links between lifestyle behaviors and the development of hypertension over time.