Hypertension during adolescence more than doubles the risk of incident stroke before the age of 50 years, according to a study from Israel published in the journal Stroke.¹

This study involved 1.9 million adolescents, aged 16-19 years, who underwent medical assessment, including screening for hypertension, prior to their recruitment for compulsory military service from 1985 to 2013. Nearly 60% of the participants were male. The primary outcome was the first incidence of ischemic and hemorrhagic stroke registered at the national stroke registry between 2014 and 2019. The objective of the study was to explore the association between hypertension during adolescence and risk for stroke in young adulthood.

A total of 1474 (0.08%) strokes occurred at a median age of 43 years, of which 1236 (84%) were ischemic strokes. Overall, 18 (0.35%) occurred among the 5221 adolescents who had a history of hypertension at baseline. After adjusting for confounding variables like BMI and baseline sociodemographic factors, the hazard ratio (HR) for incident stroke in hypertensive adolescents was 2.4. When participants who were diagnosed with diabetes during adolescence or developed incident diabetes diagnosed during the follow-up period were excluded, the HR for new onset stroke among people with adolescent hypertension was found to be 2.1. For ischemic stroke, the HR was 2.0.

This study illustrates that adolescents with hypertension face a higher risk of early-onset first stroke, ischemic stroke in particular, in young adults before 50 years of age. This risk was independent of other traditionally associated risk factors such as diabetes, obesity during adolescence. Hence, physicians treating adolescents should be aware of this association and screen them for hypertension. Early treatment may have potential benefits. However, the authors write, “As our study is observational in nature, we cannot infer explicit causality.”

Reference

1. Fishman B, et al. Adolescent hypertension is associated with stroke in young adulthood: a nationwide cohort of 1.9 million adolescents. Stroke. 2023 May 4. doi: 10.1161/STROKEAHA.122.042100.