Adolescent hypertension was associated with a significantly increased risk of early cardiovascular disease compared with normal blood pressure (HR 2.42; 95% CI 1.87-3.12).
Cohort (n=902,741)
Does elevated blood pressure in adolescence increase the risk of early cardiovascular events before age 50?
Higher blood pressure during adolescence is strongly associated with an increased risk of early cardiovascular disease before age 50, suggesting a need to refine current adolescent BP guidelines.
Hazard Ratio: 2.42 (95% CI 1.87–3.12)
BACKGROUND: Adolescent blood pressure guidelines rely on expert consensus because evidence on cardiovascular outcomes is limited. This study aimed to examine the link between adolescent blood pressure indices and early cardiovascular events. METHODS: We conducted a cohort study among 902 741 adolescents aged 16 to 19 years who were evaluated for mandatory service from 1979 to 2019, excluding those with preexisting cardiometabolic conditions. Individuals were followed until 50 or death or insurance loss or December 31, 2021, whichever occurred first. Exposures included baseline blood pressure and American Academy of Pediatrics categories: normal (<120/<80), elevated (120/<80-129/<80), stage 1 (130/80-139/89), stage 2 (≥140/90), and hypertension (clinical diagnosis). The primary outcome was incident cardiovascular events (ischemic heart disease or cerebrovascular disease). Hazard ratios were estimated using Cox models adjusted for demographic, socioeconomic, and clinical confounders. RESULTS: During over 18 million person-years of follow-up, 6305 cardiovascular disease events were recorded, yielding an incidence rate of 0.35 per 1000 person-years. Increased diastolic, systolic, and mean arterial blood pressure were significantly associated with increased risk. Compared with the Normal group, adjusted hazard ratios for cardiovascular disease were 1.14 (95% CI, 1.08-1.22) for stage 1, 1.31 (1.20-1.44) for stage 2, and 2.42 (1.87-3.12) for hypertension. Risk in the stage 1 category was particularly sensitive to diastolic blood pressure. CONCLUSIONS: Higher blood pressure indices during adolescence were strongly associated with an elevated risk of early cardiovascular disease, highlighting the potential need to refine current guidelines to better reflect cardiovascular risk.
Tsur et al. (2026) conducted a cohort in Cardiovascular disease (n=902,741). Hypertension (clinical diagnosis) vs. Normal blood pressure (<120/<80) was evaluated on Incident cardiovascular events (ischemic heart disease or cerebrovascular disease) (HR 2.42, 95% CI 1.87-3.12). Adolescent hypertension was associated with a significantly increased risk of early cardiovascular disease compared with normal blood pressure (HR 2.42; 95% CI 1.87-3.12).