BP Level in Late Adolescence and Risk for CV Events

Quick Takes

  • BP measured in late adolescence is positively associated with risk for CVD events, including MI, heart failure, and ischemic stroke.
  • The cumulative risk for CV events increased by increasing BP stages, from 14.7% for normal BP to 24.3% for stage 2 systolic–diastolic hypertension at age 68 years.
  • For those with stage 2 systolic–diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg) in adolescents, the adjusted hazard ratio for CV mortality was 2.11 (95% CI, 1.86-2.41).

Study Questions:

Is blood pressure (BP) during adolescence associated with risk of future cardiovascular (CV) events?


The investigators used a retrospective cohort study design to examine data on BP measured during adolescence with CV events later in life. Swedish adolescent males conscripted into the military between 1960 and 1997 were included. Baseline BP was measured at the time of conscription. BP was classified into eight mutually exclusive categories using American College of Cardiology/American Heart Association (ACC/AHA) terminology, with separate systolic and diastolic phenotypes from normal BP (systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg) to stage 2 systolic–diastolic hypertension (SBP ≥140 mm Hg and DBP ≥90 mm Hg). The primary outcome was a composite of CV death or first hospitalization for myocardial infarction (MI), heart failure, ischemic stroke, or intracerebral hemorrhage, which was assessed through linkage with the Swedish inpatient register and the Swedish cause of death register.


A total of 1,366,519 males, mean age of 18.3 years, were included in the analysis. The baseline BP was classified as elevated (120-129/<80 mm Hg) for 28.8% of participants and hypertensive (≥130/80 mm Hg) for 53.7%. Over a median follow-up of 35.9 years (48,923,273 person-years), 79,644 first CV disease (CVD) events occurred, including 32,791 participants hospitalized for MI, 18,118 hospitalized for heart failure, 5,064 hospitalized for intracerebral hemorrhage, and 17,623 hospitalized for ischemic stroke. The number of CVD-related deaths was 22,028, and the number of deaths due to any cause was 64,759.

The cumulative risk for the CV events in the composite outcome increased across all BP stages, with risks of 14.7% for normal BP, 15.7% for elevated BP, 16.6% for stage 1 isolated systolic hypertension (ISH), 17.4% for stage 1 isolated diastolic hypertension (IDH), 19.0% for stage 1 systolic–diastolic hypertension (SDH), 18.6% for stage 2 ISH, 21.2% for stage 2 IDH, and 24.3% for stage 2 SDH at age 68 years. The adjusted hazard ratio was 1.10 for elevated BP (95% confidence interval [CI], 1.07-1.13), 1.15 for stage 1 ISH (95% CI, 1.11-1.18), 1.23 for stage 1 IDH (95% CI, 1.18-1.28), 1.32 for stage 1 SDH (95% CI, 1.27-1.37), 1.31 for stage 2 ISH (95% CI, 1.28-1.35), 1.55 for stage 2 IDH (95% CI, 1.42-1.69), and 1.71 for stage 2 SDH (95% CI, 1.58-1.84).


The authors concluded that increasing BP levels in late adolescence are associated with gradually increasing risks for major CV events, beginning at a BP level of 120/80 mm Hg.


These data from a large observational cohort support the measurement of BP during late adolescence to assist in identifying males at higher risk for CVD events. Understanding if lowering BP during young adulthood and beyond is associated with CVD risk reduction is warranted. In addition, understanding these associations in women and other populations is also reasonable.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, CHD and Pediatrics and Prevention, Prevention

Keywords: Adolescent, Blood Pressure

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