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Adolescent Blood Pressure and Early Age Stroke
Boris Fishman1,2,3,4, Adi Vinograd5, Avishai M Tsur2,3,6,7,8
1Division of Cardiology, Sheba Medical Center, Ramat Gan, Israel.
NEJM Evidence
|November 17, 2024
Summary
Elevated adolescent diastolic blood pressure (DBP) is linked to increased stroke risk in young adults. Even slightly elevated DBP (70-79 mmHg) in females raises stroke risk, highlighting the need for sex-specific BP guidelines.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Stroke incidence is rising in young adults, partly due to underdiagnosed risk factors.
- Current adolescent blood pressure (BP) guidelines lack sex specificity and outcome-based evidence.
Purpose of the Study:
- To investigate the association between adolescent blood pressure and long-term stroke risk.
- To determine if sex-specific BP thresholds are necessary for predicting young adult stroke.
Main Methods:
- Nationwide, population-based retrospective cohort study of 1,897,048 Israeli adolescents (1985-2013).
- Primary outcome: first stroke event (ischemic or hemorrhagic) up to age 52, using the Israeli National Stroke Registry.
- Cox proportional hazard models stratified by sex, adjusted for covariates.
Main Results:
- In men, adolescent DBP ≥80 mmHg was associated with increased stroke risk (aHR 1.28).
- In women, adolescent DBP ≥80 mmHg (aHR 1.38) and 70-79 mmHg (aHR 1.41) were associated with increased stroke risk.
- Elevated adolescent systolic BP (≥120 mmHg) showed no association with stroke risk.
Conclusions:
- Adolescent diastolic blood pressure ≥80 mmHg is a significant risk factor for young adult stroke in both sexes.
- Elevated systolic BP in adolescence does not appear to be a stroke risk factor.
- Findings suggest the need for sex-specific BP monitoring and risk assessment in adolescents.
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