Connection Between Blood Pressure in Adolescence and the Risk of Developing Atherosclerosis in Midlife

Summary:
Elevated blood pressure during adolescence has been linked to a higher risk of developing cardiovascular disease later in life. A population-based cohort study using data from the Swedish Military Conscription Register and the Swedish Cardiopulmonary Bioimage Study (SCAPIS) followed 10,222 men to examine whether adolescent BP is associated with atherosclerosis in middle age. The findings showed that individuals with higher BP—particularly systolic BP and stage 2 hypertension—had greater odds of developing coronary and carotid atherosclerosis, including mixed and calcified plaques. Overall, the results indicate that elevated BP in adolescence is strongly associated with an increased risk of atherosclerosis later in life. 

Higher blood pressure (BP) during early life has been associated with an increased likelihood of developing cardiovascular disease (CVD) and experiencing CVD-related death in adulthood. Earlier research has linked elevated BP in childhood and adolescence with indicators of vascular injury later in life, such as greater carotid intima–media thickness, increased pulse wave velocity, and reduced endothelial function. However, the association between BP levels during adolescence and the presence of atherosclerosis in midlife, evaluated through coronary computed tomography angiography (CCTA), has not been previously investigated.

A population-based cohort study examined the relationship between adolescent blood pressure and the presence of coronary and carotid atherosclerosis in middle age. The analysis combined data from the Swedish Military Conscription Register (1972–1987) with information from the Swedish Cardiopulmonary Bioimage Study (SCAPIS). Multinomial logistic regression models were applied to calculate odds ratios (ORs) assessing the link between adolescent BP and atherosclerosis-related outcomes.

The study included 10,222 men with a mean age of 18.3 ± 0.5 years. At the time of conscription, the average systolic BP (SBP) was 127.6 ± 10.7 mmHg, while the average diastolic BP (DBP) was 68.3 ± 9.5 mmHg. Among participants, 1,723 individuals (16.9%) were categorized as having stage 2 hypertension. By middle age, coronary stenosis was identified in 54.3% of the participants, with 45.7% showing 1%–49% stenosis and 8.6% demonstrating stenosis of ≥50%. Furthermore, 52.0% had a coronary artery calcium (CAC) score greater than 0, and carotid plaque was present in 60.6% of the cohort. Stage 2 hypertension was linked to increased odds of mixed plaques (OR 1.73; 95% CI 1.33–2.25) and calcified plaques (OR 1.38; 95% CI 1.18–1.61).

Overall, the results indicated that elevated blood pressure during adolescence is associated with a greater likelihood of coronary atherosclerosis in middle age, particularly in individuals with higher systolic BP. These findings suggest that increased BP in adolescence is strongly related to a higher risk of developing atherosclerosis later in life.