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Background  In the U.S., young adults (18–39 year-olds) have the lowest hypertension control rates among hypertensive adults. Understanding young adults’ unique perceptions about hypertension and perceived barriers to hypertension control is critical to develop effective interventions for this population. This multi-center study explored young adults’: 1) emotions and reactions after a hypertension diagnosis, 2) attitudes about managing hypertension (lifestyle changes, follow-up visits, antihypertensive medication use), 3) opinions about their healthcare system’s hypertension education materials, and 4) opinions about using social media to manage hypertension.    Methods  Young adults (18–39 year-olds) with a diagnosis of hypertension and regular primary care access were recruited by the Wisconsin Research and Education Network (WREN). Two focus groups (one per age range: 18–29 years, 30–39 years) were conducted in three Midwestern Family Medicine Clinics (academic, rural, and urban). Conventional content analysis was performed.    Results  Thirty-eight young adults (mean: 26.7 [9.6] years old, 34 % male, 45 % Black, 42 % with ≥1 year of college) identified barriers to managing hypertension. Emergent themes overlapped across age groups and geographic regions. Most respondents were surprised and angry about a hypertension diagnosis; they expected to develop hypertension, but at a much older age. A hypertension diagnosis negatively altered their “young” self-identity; suggested behavior changes and antihypertensive medications made them feel “older” than their peers. Young adults missed blood pressure follow-up visits due to co-payments, transportation barriers, and longer than desired wait times for brief visits. Contrary to our hypothesis, most young adults disliked social media or text messaging to support self-management; they were most concerned that their peers would see the hypertension communication. Current hypertension education materials were described as not addressing young adults’ health questions and are often discarded before leaving the clinic.    Conclusions  Targeting interventions to young adults’ unique needs is necessary to improve hypertension control and cardiovascular preventive healthcare delivery.

“I have to live like I’m old.” Young adults’ perspectives on managing hypertension: a multi-center qualitative study