Skip to main content

Advertisement

SpringerLink
Log in

Hypertension in late adolescence and cardiovascular mortality in midlife: a cohort study of 2.3 million 16- to 19-year-old examinees

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

The effect of early hypertension on midlife cardiovascular (CV) mortality remains controversial. We assessed the association of established hypertension in late adolescence with subsequent CV mortality.

Methods

Of 2,298,130 Israeli adolescents (60 % males; age 17.4 ± 0.3 years) who underwent a compulsory medical examination prior to military service between 1967 and 2010, 8720 teenagers (0.4 %) were formally diagnosed with persistent hypertension. Using Cox proportional hazards modeling, we compared the hypertensive group to the large normotensive group with regard to time to event analysis of midlife mortality due to cerebrovascular accidents (CVA), coronary heart disease (CHD), sudden death (SD) and their summation as cardiovascular disease (CVD).

Results

During 45,729,521 person-years of follow-up, we identified 2918 CV deaths—2879 and 39 among the 2,289,410 normotensive and 8720 hypertensive adolescents, respectively. Hypertension at a young age was associated with a threefold elevation of stroke mortality compared to normotension when adjusted for sex, age at examination, birth year, country of origin, socioeconomic status, education, body mass index (BMI) and height [hazard ratio (HR) 3.12; 95 % confidence interval (CI) 1.76–5.54; p < 0.001]. There was no significant association of hypertension with CHD mortality or SD. An increased risk for overall CVD mortality among hypertensive youngsters (HR 1.51; 95 % CI 1.10–2.07) was attenuated after adjusting for BMI and other covariates (HR 1.24; 95 % CI 0.90–1.72).

Conclusions

Established hypertension at a young age was independently associated with elevated stroke mortality in midlife. This finding warrants confirmatory large-scale long-term follow-up studies to address the distant effects of adolescent hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lawes CM, Hoorn SV, Rodgers A (2008) Global burden of blood pressure related disease, 2001. Lancet 371:1513–1518

    Article  PubMed  Google Scholar 

  2. Lewington S, Clarke R, Quizilbash N, Peto R, Collins R, Prospective Studies Collaboration (2002) Age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  3. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wühl E, Zanchetti A (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742

    Article  CAS  PubMed  Google Scholar 

  4. Moyer VA (2013) Screening for primary hypertension in children and adolescents: US preventive services task force recommendation statement. Pediatrics 132:907–914

    Article  PubMed  Google Scholar 

  5. Ingelfinger JR (2014) The child or adolescent with elevated blood pressure. N Engl J Med 370:2316–2325

    Article  PubMed  Google Scholar 

  6. Stergiou GS, Yiannes NJ, Rarra VC, Alamara CV (2005) White-coat hypertension and masked hypertension in children. Blood Press Monit 10:297–300

    Article  PubMed  Google Scholar 

  7. Daniels SR, Gidding SS (2013) Blood pressure screening in children and adolescents: is the glass half empty or more than half full? JAMA Pediatr 167:302–304

    Article  PubMed  Google Scholar 

  8. Central Bureau of Statistics (CBS) (2006) Characterization and classification of local authorities by the socio-economic level of the population. In: CBS (eds) Statistics. CBS, Jerusalem.

  9. Twig G, Gluzman I, Tirosh A, Gerstein HC, Yaniv G, Afek A, Derazne E, Tzur D, Karasik A, Gordon B, Fruchter E, Lubin G, Rudich A, Cukierman-Yaffe T (2014) Cognitive function and the risk for diabetes among young men. Diabetes Care 37:2982–2988

    Article  PubMed  Google Scholar 

  10. Paffenbarger RS Jr, Wing AL (1967) Characteristics in youth predisposing to fatal stroke in later years. Lancet 1(7493):753–754

    Article  PubMed  Google Scholar 

  11. Paffenbarger RS Jr, Wing AL (1969) Chronic disease in former college students: the effect of single and multiple characteristics on risk of fatal coronary heart disease. Am J Epidemiol 90(6):527–535

    PubMed  Google Scholar 

  12. McCarron P, Smith GD, Okasha M, McEwen J (2000) Blood pressure in young adulthood and mortality from cardiovascular disease. Lancet 355(9213):1430–1431

    Article  CAS  PubMed  Google Scholar 

  13. Mangner N, Scheuermann K, Winzer E, Wagner I, Hoellriegel R, Sandri M, Zimmer M, Mende M, Linke A, Kiess W, Schuler G, Körner A, Erbs S (2014) Childhood obesity: impact on cardiac geometry and function. JACC Cardiovasc Imaging 7:1198–1205

    Article  PubMed  Google Scholar 

  14. Guven A, Ozgen T, Gungor O, Aydin M, Baysal K (2010) Association between the corrected QT interval and carotid artery intima-media thickness in obese children. J Clin Res Pediatr Endocrinol 2:21–27

    Article  PubMed Central  PubMed  Google Scholar 

  15. McGill HC Jr, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP (2000) Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 72:1307S–1315S

    CAS  PubMed  Google Scholar 

  16. Falkstedt D, Koupil I, Hemmingsson T (2008) Blood pressure in late adolescence and early incidence of coronary heart disease and stroke in the Swedish 1969 conscription cohort. J Hypertens 26:1313–1320

    Article  CAS  PubMed  Google Scholar 

  17. Sundstrom J, Neovius M, Tynelius P, Rasmussen F (2011) Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011:342:d643

  18. Gofin J, Kark JD, Abramson JH, Epstein L (1995) Trends in blood pressure levels over time in middle-aged and elderly Jerusalem residents. Eur Heart J 16:1988–1994

    CAS  PubMed  Google Scholar 

  19. Chiolero A, Bovet P, Paradis G, Paccaud F (2007) Has blood pressure increased in children in response to the obesity epidemic? Pediatrics 119(3):544–553

    Article  PubMed  Google Scholar 

  20. Seeman T, Pohl M, Palyzova D, John U (2012) Microalbuminuria in children with primary and white-coat hypertension. Pediatr Nephrol 27(3):461–467

    Article  PubMed  Google Scholar 

  21. Hogstrom G, Nordstrom A, Eriksson M, Nordstrom P (2015) Risk factors assessed in adolescence and the later risk of stroke in men: a 33 year follow-up study. Cerebrovasc Dis 39:63–71

    Article  PubMed  Google Scholar 

  22. Keith SW, Fontaine KR, Pajewski NM, Mehta T, Allison DB (2011) Use of self-reported height and weight biases the body mass index-mortality association. Int J Obes 35:401–408

    Article  CAS  Google Scholar 

  23. Chiolero A, Bovet P, Paradis G (2013) Screening for elevated blood pressure in children and adolescents- a critical appraisal. JAMA Pediatr 167(3):266–273

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel

      Adi Leiba, Gilad Twig, Arnon Afek & Ari Shamiss

    2. The Israel Defense Forces Medical Corps, Ramat Gan, Israel

      Adi Leiba, Gilad Twig, Estela Derazne & Dorit Tzur

    3. Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA

      Adi Leiba

    4. The Dr. Pinchas Bornstein Talpiot Medical Leadership Program and Department of Medicine B, Sheba Medical Center, Ramat Gan, Israel

      Gilad Twig

    5. Hebrew University–Hadassah School of Public Health and Community Medicine, Jerusalem, Israel

      Hagai Levine & Jeremy D. Kark

    6. Israel Ministry of Health, Jerusalem, Israel

      Nehama Goldberger, Arnon Afek & Ziona Haklai

    Authors
    1. Adi Leiba
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Gilad Twig
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Hagai Levine
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Nehama Goldberger
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Arnon Afek
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Ari Shamiss
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Estela Derazne
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Dorit Tzur
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Ziona Haklai
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Jeremy D. Kark
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Adi Leiba.

    Ethics declarations

    The Israel Defense Forces Medical Corps Institutional Review Board approved the study and waived the need for personal informed consent. After data linkage with the Ministry of Health mortality database, personal identifiers were permanently deleted from the computer file so that all analyses were undertaken on anonymous records.

    Financial disclosure

    This study was supported by a research grant from the Environment and Health Fund (Israel) Award No. RGA 1002 to JDK.

    Competing interests

    The authors declare that they have no competing interests.

    Additional information

    Adi Leiba and Gilad Twig contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Leiba, A., Twig, G., Levine, H. et al. Hypertension in late adolescence and cardiovascular mortality in midlife: a cohort study of 2.3 million 16- to 19-year-old examinees. Pediatr Nephrol 31, 485–492 (2016). https://doi.org/10.1007/s00467-015-3240-1

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00467-015-3240-1

    Keywords

    Search

    Navigation