High BP in males in late adolescence may increase risk of major CV events later in life

A study of more than one million Swedish men followed for up to 50 years found that higher blood pressure (BP) at age 18 was associated with an increased risk for major cardiovascular events later in life, including heart failure, heart attacks, strokes, and mortality. The risk for major cardiac events became elevated beginning at a BP of 120/80 mm Hg. According to the researchers, early intervention for hypertension may be critical to reducing later cardiovascular events. The findings are published in Annals of Internal Medicine.

Hypertension is the leading cause of cardiovascular disease (CVD) and premature death in the world. The association between BP level and cardiovascular outcomes has been extensively studied in middle-aged and older persons, but not enough is known about the association between BP in adolescence and future cardiovascular events.

Researchers from Umeå University and Uppsala University studied 1,366,519 men enlisted in the Swedish military between 1969 and 1997 to measure the association between high blood pressure in adolescence and risk for cardiovascular events in adulthood. The participants’ baseline BP was measured during conscription. Using the American College of Cardiology/American Heart Association guidelines for classifying BP elevation, the baseline BP was classified as elevated at 120 to 129/<80 mm Hg. Based on these measurements, 28.8 percent of participants had an elevated baseline BP and 53.7 percent had a hypertensive baseline BP.

Over up to 50 years follow up, the researchers found a substantial and gradual absolute risk increase across BP categories for all major cardiovascular outcomes in adulthood. One in 10 adolescents with combined stage 2 hypertension would have a major cardiovascular event before retirement, whereas those with BP below 120/80mmHg would not. According to the authors, the results of this study highlight the possibility of identifying persons with increased cardiovascular risk in late adolescence, enabling early intervention to prevent CVD. This possibility should encourage practitioners to measure BP in adolescents, which is not done routinely.

Reference:

Helene Rietz, Johanna Pennlert, Peter Nordström, and Mattias Brunström, Helene Rietz, MD, Johanna Pennlert, MD, PhD, Peter Nordström, MD, PhD, and Mattias Brunström, https://doi.org/10.7326/M23-0112.