Blood Pressure Level in Late Adolescence and Risk for Cardiovascular Events : A Cohort Study

Ann Intern Med. 2023 Oct;176(10):1289-1298. doi: 10.7326/M23-0112. Epub 2023 Sep 26.

Abstract

Background: Not enough is known about the association between blood pressure (BP) in adolescence and future cardiovascular events.

Objective: To measure this association using the 2017 American College of Cardiology/American Heart Association guidelines for classifying BP elevation.

Design: Cohort study.

Setting: Sweden.

Participants: Males in late adolescence who were conscripted into the military from 1969 to 1997.

Measurements: Baseline BP was measured at conscription. The primary outcome was a composite of cardiovascular death or first hospitalization for myocardial infarction, heart failure, ischemic stroke, or intracerebral hemorrhage.

Results: The study included 1 366 519 males with a mean age of 18.3 years. The baseline BP was classified as elevated (120 to 129/<80 mm Hg) for 28.8% of participants and hypertensive (≥130/80 mm Hg) for 53.7%. During a median follow-up of 35.9 years, 79 644 had a primary outcome. The adjusted hazard ratio was 1.10 for elevated BP (95% CI, 1.07 to 1.13), 1.15 for stage 1 isolated systolic hypertension (ISH) (CI, 1.11 to 1.18), 1.23 for stage 1 isolated diastolic hypertension (IDH) (CI, 1.18 to 1.28), 1.32 for stage 1 systolic-diastolic hypertension (SDH) (CI, 1.27 to 1.37), 1.31 for stage 2 ISH (CI, 1.28 to 1.35), 1.55 for stage 2 IDH (CI, 1.42 to 1.69), and 1.71 for stage 2 SDH (CI, 1.58 to 1.84). The cumulative risk for cardiovascular events also increased gradually across BP stages, ranging from 14.7% for normal BP to 24.3% for stage 2 SDH at age 68 years.

Limitation: This was an observational study of Swedish men.

Conclusion: Increasing BP levels in late adolescence are associated with gradually increasing risks for major cardiovascular events, beginning at a BP level of 120/80 mm Hg.

Primary funding source: Västerbotten County Council, Swedish Society for Medical Research, and Heart Foundation of Northern Sweden.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Aged
  • Blood Pressure / physiology
  • Cardiovascular Diseases* / etiology
  • Cerebral Hemorrhage
  • Cohort Studies
  • Humans
  • Hypertension* / complications
  • Hypertension* / epidemiology
  • Male
  • Myocardial Infarction* / complications
  • Risk Factors