The clinical implications of this inference are potentially profound. Despite adult hypertension guidelines that recommend treatment of hypertension regardless of age (15), young adults with hypertension are less likely than older age groups to be aware of their hypertension, to be on treatment, and to have their hypertension adequately controlled (16). Although improvements have been made across all of these parameters over time, improvements have consistently lagged in young adults. Several factors may contribute to undertreatment of hypertension in this age group. Young adults are likely to lack health insurance, to lack a usual source of care, and to interact with the medical system only for episodic care (17). Physicians caring for young adults may be reluctant to label them with a medical diagnosis that may have implications for future insurance, jobs, and perceptions of health. Physicians may also have concerns about treating a risk factor such as hypertension when the benefits of such treatments may be several decades in the future and the long-term safety of medical treatment may be questioned. Although these concerns are not easily dismissed, the reality of the growing national burden of hypertension remains. For young adults and the physicians and healthcare systems that care for them, the difficult challenge of optimizing blood pressure in young men and women in their 20s and 30s is likely to grow more difficult with rising rates of obesity (18- 19). Optimizing blood pressure in young African Americans is a particularly difficult and important challenge: blood pressure elevations in African Americans are more likely to begin earlier in life (20), and the spectrum of hypertensive-related morbidity occurs at younger ages, contributing importantly to premature morbidity and mortality and associated health disparities (21- 22).