Adolescent BP Predicts Progression to Hypertension in Young Adulthood

"Although prehypertension at adolescence is accepted to indicate increased future risk of hypertension, large-scale/long follow-up studies are required to better understand how adolescent ...BP tracks into young adulthood," write Amir Tirosh, MD, PhD, from Brigham and Women's Hospital in Boston, Massachusetts, and colleagues. 

The study cohort consisted of 23,191 male and 3,789 female adolescents enrolled in the Metabolic Lifestyle and Nutrition Assessment in Young Adults study. At baseline, mean age was 17.4 years, and BP was less than 140/90 mm Hg or categorized according to current criteria for pediatric BP and body mass index (BMI) values. Incidence of hypertension was determined retrospectively between the ages of 17 and 25 years and prospectively with repeated BP measurements between the ages of 25 and 42 years. 

Between the ages of 17 and 42 years, 3,810 new cases of hypertension were detected, with a cumulative risk for hypertension 3 to 4 times higher in men vs women, based on survival analyses. Cox regression models adjusted for age and BMI and stratified by baseline BP showed that the hazard ratio (HR) of hypertension increased gradually across BP groups within the normotensive range at age 17 years. There was no apparent threshold effect. In the group with BP 130 to 139/85 to 89 mm Hg, the HR was 2.50 (95% confidence interval [CI], 1.75 - 3.57) for boys and 2.31 (95% CI, 0.71 - 7.60) for girls. 

"Blood pressure values well below the hypertensive range already can serve as good predictors for future hypertension," Dr. Tirosh said in a news release. "The rate of progression to hypertension is higher in teenagers whose systolic blood pressure is 110 versus those whose blood pressure is 100 and is different between boys and girls." 

Even after adjustment for BP at age 17 years, BMI at that age was strongly associated with a future risk for hypertension, especially in boys. However, BMI at age 30 years attenuated this association, especially in girls. 

"BMI is considered an independent risk factor that interacts with blood pressure to predict future risk of hypertension," Dr. Tirosh said. "Together, these factors provide a simple and useful tool that can serve as a red flag to detect subgroups of teens at high risk of hypertension as adults while in their teens."

"It is never too early to start lifestyle modification and intervene to prevent hypertension, heart disease and diabetes," Dr. Tirosh concluded. "Hypertension, heart disease and their prevention have been perceived as more relevant to an older population, but now we know that slight changes in blood pressure and weight should represent an alert for pediatricians to begin prevention as early as possible. It is better to prevent a disease than treat it."