Significance of Hypertension in Early Adulthood Research (SHEAR) (360G-Wellcome-227647_Z_23_Z)

Essential hypertension is the leading preventable cause of cardiovascular disease and death, and has traditionally been associated with ageing. However, high prevalence of elevated blood pressure (BP) has increasingly been reported among youth in sub-Saharan Africa (SSA), posing challenges for clinical management. My fellowship will address critical evidence gaps on BP among youth in SSA. I will examine: \- population prevalence of hypertension in urban Zimbabwean youth and the agreement between routine brachial BP and the potentially more clinically-predictive central aortic BP. \- the population prevalence of early vascular ageing (EVA) and hypertension-mediated organ damage (HMOD), and the BP profiles at which they occur. \- the context- specific aetiological factors associated with elevated blood pressure, EVA and HMOD. I will conduct a detailed cross-sectional study of 650 individuals, randomly selected from a large population-based health survey of youth conducted in Zimbabwe in 2022 (N~17,000; 18-24y). This will provide population estimates of brachial and central hypertension, EVA and HMOD. I will examine risk factors and measure novel biomarkers (including immune markers, telomere length analyses and metabolomics) to conduct state-of-the-art causal inference studies. The fellowship will have clinically important implications for hypertension screening, prevention and treatment guidelines for youth in SSA.