Not enough is known about the association between blood pressure (BP) in adolescence and future cardiovascular events.
We measured this association using the 2017 American College of Cardiology/American Heart Association guidelines for classifying BP elevation.
Baseline blood pressure was measured at recruitment. The primary outcome was a composite of cardiovascular death or first hospitalization for myocardial infarction, heart failure, ischemic stroke, or intracerebral hemorrhage.
The study included 1,366,519 men with an average age of 18.3 years.
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 isolated diastolic hypertension (IDH) (CI, 1.42 to 1.69), and 1.71 for SDH stage 2 (CI, 1.58 to 1.84).
The cumulative risk of cardiovascular events also gradually increased across all BP stages, ranging from 14.7% for normal BP to 24.
This was an observational study of Swedish men.
Increasing BP levels in late adolescence are associated with increasing risks of major cardiovascular events, starting with a BP level of 120/80 mm Hg.
Primary funding source: Västerbotten County Council, Swedish Medical Research Society and Northern Sweden Heart Foundation.
