24-h Movement Behaviors and Incident Hypertension Among Adolescents: A Prospective Study From the ABCD Study

Hypertension during adolescence is a growing public health concern with long-term cardiovascular implications. This study examined whether adherence to 24-h movement behavior guidelines-physical activity, screen time, and sleep-was associated with the prevalence and incidence of hypertension among U.S. adolescents, and whether these associations varied by social determinants of health (SDoH). We analyzed data from 2067 participants in the Adolescent Brain Cognitive Development (ABCD) Study, followed across 21 U.S. cities from 2018-2020 (T0) to 2020-2022 (T1). Movement behaviors were dichotomized using international recommendations, and SDoH was measured using the Child Opportunity Index. Hypertension was defined as systolic or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Adolescents with screen time > 2 h/day had higher hypertension prevalence (1.9%) and incidence (4.0%) than those within recommended limits. In crude analyses, adolescents meeting physical activity guidelines showed a higher incidence of hypertension than those not meeting them; however, this association was not statistically significant in adjusted models (RR = 0.87; 95% CI: 0.42-4.17), suggesting that confounding rather than a true effect may explain the crude finding. Adherence to two or more movement behavior recommendations was associated with a reduced risk of hypertension (RR = 0.31; 95% CI: 0.09-0.98), though this estimate is based on a small number of events and should be interpreted with caution. SDoH did not modify these associations. These findings underscore the importance of combined behavioral adherence in reducing hypertension risk and support the integration of lifestyle interventions for promoting cardiovascular health during adolescence.