Adolescent hypertension may increase stroke risk more than twofold by midlife
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Key takeaways:
- Hypertension during adolescence was associated with a more than twofold increased risk for stroke by midlife.
- Findings were consistent even after adjusting for BMI, sociodemographics and diabetes.
In a large Israeli cohort, adolescent hypertension was associated with a more than twofold increased risk for stroke by midlife, even after adjustment for BMI, baseline sociodemographic factors and diabetes.
An analysis linking the Israeli Defense Forces conscription center database with the Israeli National Stroke Registry was published in Stroke.
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“This research demonstrates that adolescents with hypertension are at increased risk for stroke as young adults, regardless of other important possible concomitant risk factors such as obesity during adolescence and diabetes mellitus status throughout adulthood. This study is part of our continuous effort to study the deleterious long-term effects of hypertension in early life, which seems to be an emerging problem since the prevalence of adolescent hypertension seemed to have doubled within less than 2 decades,” Gilad Twig, MD, MPH, PhD, professor at the population health research center at the Gertner Institute for Epidemiology and Health Policy Research at Sheba Medical Center, told Healio. “We have shown using nationwide databases that adolescent hypertension increases the risk of future cardiovascular mortality, kidney disease and new onset diabetes. Here, we designed the study to specifically look on early onset stroke — before age 50 — as this devastating disease is becoming more prevalent in many Western countries.”
For this nationwide, retrospective study, Fishman and colleagues linked the Israeli Defense Forces conscription center database to the Israeli National Stroke Registry to better understand the association between hypertension during adolescence and risk for stroke in young adulthood.
The analysis included more than 1.9 million participants aged 16 to 19 years evaluated before compulsory military service in Israel between 1985 and 2013 (median age, 17 years; 58% male).
The primary outcome was ischemic and hemorrhagic stroke incidence as registered in the Israeli National Stroke Registry.
In the overall cohort, the incidence rate of stroke was 0.08% (84% ischemic stroke), and the median age at time of stroke was 43 years.
Overall, 0.3% of adolescent participants had hypertension at baseline. Of these, stroke occurred in 0.35%.
After adjusting for BMI and baseline sociodemographic factors, the HR for stroke among people with adolescent hypertension was 2.4 (95% CI, 1.5-3.9).
After further adjustment for diabetes, the HR for stroke among people with adolescent hypertension was 2.1 (95% CI, 1.3-3.5), and findings were similar when the outcome was ischemic stroke (HR = 2; 95% CI, 1.2-3.5).
“The most important takeaway for physicians taking care of adolescents and young adults is to be aware of the possible deleterious effects and therefore to screen for hypertension. Our study did not evaluate the effect of treatment and therefore we cannot make explicit recommendations on treatment quality,” Twig told Healio. “However, as the age range — 16 to 19 years — is close to adulthood and their physiology is more similar to adults, we can assume that treatment benefits in the long run would be similar to those shown for adults. We would strongly recommend and encourage that this be further assessed in future clinical trials, especially in light of the increasing prevalence of adulthood hypertension.”
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